The History of Extracorporeal Membrane Oxygenation and the Development of Extracorporeal Membrane Oxygenation Anticoagulation

Authors: Bartlett, Robert; Arachichilage, Deepa J.; Chitlur, Meera; Hui, Shiu-Ki Rocky; Neunert, Cindy; Doyle, Andrew; Retter, Andrew; Hunt, Beverley J.; Lim, Hoong Sern; Saini, Arun; Renné, Thomas; Kostousov, Vadim; Teruya, Jun

Affiliations: Department of Surgery, University of Michigan, Ann Arbor, Michigan. Centre for Haematology, Department of Immunology and Inflammation, Imperial College London, London, United Kingdom. Department of Haematology, Imperial College, Healthcare NHS Trust, London, United Kingdom. Division of Hematology/Oncology, Central Michigan University School of Medicine, Children’s Hospital of Michigan, Michigan. Department of Pathology & Immunology, Texas Children’s Hospital and Baylor College of Medicine, Houston, Texas. Columbia University Irving Medical Center, New York, New York. St Thomas’ Hospital, London, United Kingdom. University Hospitals Birmingham NHS Foundation Trust, United Kingdom. Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany. Center for Thrombosis and Hemostasis (CTH), Johannes Gutenberg University Medical Center, Mainz, Germany. Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.

Publication: Seminars in thrombosis and hemostasis. 2024. 50. 81–90

ABSTRACT: Extracorporeal membrane oxygenation (ECMO) was first started for humans in early 1970s by Robert Bartlett. Since its inception, there have been numerous challenges with extracorporeal circulation, such as coagulation and platelet activation, followed by consumption of coagulation factors and platelets, and biocompatibility of tubing, pump, and oxygenator. Unfractionated heparin (heparin hereafter) has historically been the de facto anticoagulant until recently. Also, coagulation monitoring was mainly based on bedside activated clotting time and activated partial thromboplastin time. In the past 50 years, the technology of ECMO has advanced tremendously, and thus, the survival rate has improved significantly. The indication for ECMO has also expanded. Among these are clinical conditions such as post cardiopulmonary bypass, sepsis, ECMO cardiopulmonary resuscitation, and even severe coronavirus disease 2019 (COVID-19). Not surprisingly, the number of ECMO cases has increased according to the Extracorporeal Life Support Organization Registry and prolonged ECMO support has become more prevalent. It is not uncommon for patients with COVID-19 to be on ECMO support for more than 1 year until recovery or lung transplant. With that being said, complications of bleeding, thrombosis, clot formation in the circuit, and intravascular hemolysis still remain and continue to be major challenges. Here, several clinical ECMO experts, including the « Father of ECMO »-Dr. Robert Bartlett, describe the history and advances of ECMO.