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Published on: January 17, 2025
Safety of Invasive Procedures During Adult Extracorporeal Membrane Oxygenation: A Systematic Review
Giuseppe Neri1, Giuseppe Mazza1, Helenia Mastrangelo2
1Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, 88100 Catanzaro, Italy.
Journal of Clinical Medicine
|June 26, 2026
Summary
Performing invasive procedures during adult extracorporeal membrane oxygenation (ECMO) is feasible but carries risks. Safety varies by procedure type, urgency, and anticoagulation strategy, requiring careful planning and multidisciplinary care.
Area of Science:
- Critical Care Medicine
- Cardiovascular Surgery
- Pulmonology
Background:
- Adult patients on extracorporeal membrane oxygenation (ECMO) often need invasive procedures.
- ECMO-related anticoagulation and coagulopathy increase bleeding and thrombotic risks during these procedures.
Purpose of the Study:
- To systematically review the safety of invasive procedures performed during adult ECMO support.
- To exclude tracheostomy/tracheotomy from the review scope due to recent dedicated analysis.
Main Methods:
- Systematic search of PubMed/MEDLINE and Scopus databases.
- Included studies with adult ECMO patients undergoing invasive procedures or using ECMO for procedural support.
- Primary outcomes: procedure-related complications, bleeding, and transfusion needs.
Main Results:
- 46 studies were included, covering airway, thoracic, abdominal, lung transplant, cardiovascular, and mixed surgeries.
- Airway procedures showed high success, but tracheal procedures had 26% hemorrhagic complications.
- Emergency thoracic/abdominal procedures had the highest bleeding, transfusion, reintervention, and mortality rates.
Conclusions:
- Invasive procedures are feasible in selected adult ECMO patients at experienced centers.
- Procedural safety is highly dependent on procedure type, urgency, patient condition, and anticoagulation.
- A multidisciplinary, individualized approach to anticoagulation and planning is crucial for safety.
