ExtracorporeaL life support and Modification Of Hemostasis: the ELMOH trial: hemostatic changes during the first 48 h of VV- and VA-ECMO: a prospective multicenter cohort study
Authors' conclusion
Early hemostatic profiles differed markedly between patients requiring ECMO for circulatory failure and those supported for isolated respiratory failure. VA-ECMO showed lower platelet counts and a more hypocoagulable profile early after initiation that partially improved within 48 h, whereas VV-ECMO remained relatively hypercoagulable.
Study context
- Population
- Adults initiated on VV- or VA-ECMO in four Belgian ICUs, 03/2021–01/2023
- Participants
- 43 adults
- Exposure
- VV-ECMO vs VA-ECMO
- VVn = 23
- Venoarterial (VA)n = 20
- Outcome
- Standard coagulation tests and viscoelastic (ROTEM) profiles, related to early bleeding and transfusion need
- Follow-up
- First 48 h of ECMO
Methodological detailsmulticentre
- Multicentre
Main finding
As reported in the abstract
Platelet count at inclusion and haemostatic profiles over the first 48 h · inclusion to + 48 h
VV
292
median
- Platelet counts at inclusion higher in VV than in VA (median, as printed)
- 292 vs. 145.109/L
- Thrombocytopenia present at enrolment
- 30%
- Thrombocytopenia developed during the first 48 h
- 56%
- Significant platelet decline in both modes
- P < 0.001
Observational data: associations, not effects.
Further findings
One-year survival
Transfusion
- Transfusion overall
- 58%
- No FFP given to VV patients (significantly fewer than VA)
Safety
Early bleeding, BARC ≥ 2
Early bleeding, GUSTO moderate/severe
- Early bleeding, BARC ≥ 2 — Overall
- 37%
- Early bleeding, GUSTO moderate/severe — Overall
- 21%
Early bleeding, BARC ≥ 2
- Between-group differences nonsignificant
Early bleeding, GUSTO moderate/severe
- Between-group differences nonsignificant
Original publication
ExtracorporeaL life support and Modification Of Hemostasis: the ELMOH trial: hemostatic changes during the first 48 h of VV- and VA-ECMO: a prospective multicenter cohort study. Crit Care. Published 13 May 2026. doi:10.
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