Extracorporeal life support (ECLS) is indicated in refractory acute respiratory or
cardiac failure. According to the need for anticoagulation,
bleeding conditions (e.g., in
trauma, pulmonary
bleeding) have been considered a
contraindication for the use of ECLS. However, there is increasing evidence for improved outcomes after ECLS support in hemorrhagic patients based on the benefits of hemodynamic support outweighing the increased risk of
bleeding. We conducted a systematic literature search according to the
PRISMA guidelines and reviewed publications describing ECLS support in hemorrhagic conditions. Seventy-four case reports, four case series, seven retrospective database observational studies, and one preliminary result of an ongoing study were reviewed. In total, 181 patients were identified in total of 86 manuscripts. The reports included patients suffering from
bleeding caused by pulmonary
hemorrhage (n = 53),
trauma (n = 96), postpulmonary
endarterectomy (n = 13), tracheal
bleeding (n = 1), postpartum or cesarean delivery (n = 11), and
intracranial hemorrhage (n = 7). Lower targeted titration of
heparin infusion,
heparin-free ECLS until coagulation is normalized, clamping of the endotracheal tube, and other ad hoc possibilities represent potential beneficial maneuvers in such conditions. Once the patient is cannulated and circulation restored,
bleeding control surgery is performed for stabilization if indicated. The use of ECLS for temporary circulatory or respiratory support in critical patients with refractory
hemorrhagic shock appears feasible considering tailored ECMO management strategies. Further investigation is needed to better elucidate the patient selection and ECLS management approaches.