Nitric oxide in the ECMO circuit as a treatment option for heparin-induced thrombocytopenia: A case report

Introduction Extracorporeal membrane oxygenation (ECMO) involves the use of a synthetic circuit, which initiates a complex interplay of inflammatory and pro-coagulant responses. This intricate, self-reinforcing process results in a prothrombotic state, predisposing patients to arterial, venous, or oxygenator thrombosis. Unfractionated heparin is the standard anticoagulant chosen in ECMO patients to prevent such complications. Case Report In this case report our patient presented heparin-induced thrombocytopenia (HIT), a possible complication. Discussion Alternative strategies such as bivalirudin and argatroban are possible options but due the unavailability of those medications at our institution, nitric oxide (NO) via sweep-gas flow was deemed a reasonable alternative considering it’s anti-aggregant effect. Conclusion This case report details the use of NO as a possible alternative anticoagulant strategy in a patient with ECMO complicated by HIT.