Con: Hemostasis Management of Patients on ECMO Is Different than CPB

Extracorporeal membrane oxygenation (ECMO) and cardiopulmonary bypass (CPB) cause hematologic derangements such as consumptive coagulopathy, platelet dysfunction, and hyperfibrinolysis. These derangements put patients at risk for thrombosis and bleeding. As cardiac anesthesiologists, our approaches to managing these derangements are similar, irrespective of the extracorporeal circuit modality. In this debate, we review the specific hematologic changes seen in ECMO and CPB, identify hemostatic monitoring and treatment strategies, and ultimately draw the conclusion that the overall clinical management of hemostasis with ECMO or CPB is the same.