30: Anticoagulation Strategy with a Novel ECMO System in a Coagulopathic Patient: A Case Report on Anticoagulation-Free Management

Background: Anticoagulation strategies during veno-venous extracorporeal membrane oxygenation (VV-ECMO) are particularly challenging in patients with pre-existing coagulopathy. Methods: We report a 53-year-old female with a history of breast cancer (mastectomy, radiotherapy, chemotherapy) admitted for two-weeks of dyspnoea and diagnosed with severe pneumonia and ARDS. Despite antibiotics and mechanical ventilation, her condition deteriorated, and VV-ECMO was initiated using the Lifemotion system (CBM, China). Standard heparin-anticoagulation was initially used (target ACT: 160–180s). Results: On ECMO day 13, thrombocytopenia (38×109/L) was noted, raising concerns about HIT or prior chemotherapy effects. On day 15, active airway bleeding developed. Heparin was discontinued, and a low APTT target (28–35 s) was adopted. During anticoagulation-free support, ECMO flow remained stable (3.5–4.1 L/min), with effective oxygenation and CO2 removal. No significant difference in R value (Δp/1k RPM) was observed, suggesting biocompatibility of the phosphorylcholine-coated oxygenator. Coagulation markers (APTT, PT, TT, FBG) showed no major changes between the anticoagulated and anticoagulation-free phases. Platelet count (87.20±27.86×10/L vs 38.33±7.51×10/L) and hemoglobin level (71.60±7.02 g/L vs. 67.33±21.20 g/L) improved significantly. Despite ongoing support, the patient developed septic shock and MOF, and support was withdrawn on day 43. No mechanical complications occurred during the 43-day ECMO run. Limitations: The case report is individualized for this patient, further studies are needed to confirm safety. Conclusions: This case demonstrates that, with careful monitoring, adequate perfusion flow, and biocompatible ECMO components, anticoagulation-free strategies may be feasible and safe in selected coagulopathic patients.