Alternatives to heparin anticoagulation for cardiopulmonary bypass and extracorporeal membrane oxygenation

Cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO) are both mechanical circulatory support technologies that augment the native heart and/or lung function. They involve drainage and reinfusion of blood while performing extracorporeal gas exchange. 1 In both devices, contact between patient blood and the non-endothelialized surface of the circuit triggers an inflammatory response and pro-coagulation cascade. 2–5 As a result, prophylactic anticoagulation is integral to prevent catastrophic thrombosis of the circuitry. In rare instances, there exist contraindications to heparin use, necessitating alternative management strategies. 6 In this review, we will examine heparin contraindications in mechanical circulatory support and summarize alternative approaches to anticoagulation in these circumstances.