Evaluating and Providing Transfusion Support for Patients on Extracorporeal Membrane Oxygenation (ECMO): How the Blood Bank, the Bedside, and the Benchtop Can Boost Each Other When Patients' Lives Hang in the Balance

Proposed Session Description: ECMO is an advanced life support modality for critically ill patients with severe cardiac or respiratory failure. Its use has grown rapidly in both adult and pediatric centers, creating complex transfusion and coagulation management challenges. Despite the growth, institutional practices remain highly variable, particularly in how laboratory data are interpreted and translated into transfusion and factor replacement decisions.

This session brings together critical care, transfusion medicine, and coagulation expertise in an integrated discussion spanning the full decision pathway, from circuit physiology and bedside assessment to assay limitations and blood bank responses. It addresses the real-world friction points between disciplines rather than focusing on a single domain. Laboratory data often guide transfusions, but test limitations and real-time accuracy are not always clear, making it difficult to answer the urgent question: “What does the patient need right now to control bleeding and safely stay on ECMO while their underlying illness is treated?” Through cases, practical strategies, and audience polling, attendees will learn how to align laboratory data, bedside priorities, and institutional policies to standardize care, improve decision-making, and enhance patient safety for this high-acuity, rapidly growing patient population.

Dr. Rai will review blood bank workflows and strategies to optimize blood utilization. This will include audience polling regarding attendees’ current policies for notification, dispensing, and testing of pediatric and adult ECMO patients. Dr. Liveris will cover indications for ECMO in children and adults, bedside monitoring - including management of multidisciplinary teams, and pharmacologic and biologic support, providing the clinical context needed to anticipate transfusion needs and anticoagulation management. Dr. Cohen will discuss how ECMO induces coagulopathy, describing pathophysiology and how various clinical diagnostics can or cannot detect these changes. He will discuss how the anticoagulation mentioned by Dr. Liveris affects laboratory testing, clarifying when results should guide transfusion or factor replacement based on published evidence of optimizing outcomes for ECMO patients.