Awake Veno-Venous Extracorporeal Membrane Oxygenation Strategy and the Risk of Delayed Iliopsoas Hematoma: A Single-Center Retrospective Study.

BACKGROUND

Awake veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) has been introduced to mitigate complications associated with prolonged sedation and invasive mechanical ventilation. However, concerns remain regarding delayed hemorrhagic complications, such as iliopsoas hematoma. This study aimed to identify factors associated with the development of iliopsoas hematoma in patients undergoing awake V-V ECMO.

METHODS

Among 41 patients, we retrospectively reviewed data of seven patients who developed delayed iliopsoas hematoma during awake V-V ECMO. The ECMO configurations at our institute include: (1) femorojugular, with drainage from the femoral vein and return to the jugular vein; (2) jugulofemoral, with drainage from the jugular vein and return to the femoral vein; and (3) jugulojugular, which performs both drainage and return. Patient characteristics, timing of onset, management, and outcomes were evaluated.

RESULTS

All seven patients developed hematomas several days after ECMO initiation, often following mobilization. Compared with those without hematomas, affected patients were predominantly female (n = 6, 25%, p = 0.0352), achieved standing during rehabilitation in fewer days (4 [4, 4.5] vs. 8 [5.8, 12.3] days, p = 0.0301), and had a longer hospital stay (52.5 [47.8, 84.5] vs. 32 [19, 52] days, p = 0.043). The diagnosis was primarily made using computed tomography, and most patients were successfully treated with transcatheter arterial embolization. No death was directly attributed to the hematoma.

CONCLUSIONS

Awake V-V ECMO facilitates early mobilization but may increase the risk of delayed retroperitoneal bleeding, particularly iliopsoas hematoma. Heightened awareness and prompt recognition of this complication are essential for optimal management.