Surviving the Burn: Anticoagulation Strategies for VV ECMO in Complex Thermal Injury

Tuesday, March 24, 2026

12:30 PM - 1:30 PM Central Time

Location: Connections Central - RST 04

Daniela Feingold, MD

New York

Disclosure(s): No relevant financial relationship(s) to disclose.
Natalia R. Torres-Acevedo, MD

New York

Disclosure(s): No relevant financial relationship(s) to disclose.
AK

Adnan Khoja, N/A

Medical Student
Albert Einstein College of Medicine

Disclosure information not submitted.
TC

Terence Choy, MD

Attending Physician
Jacobi Medical Center

Disclosure information not submitted.
HL

Hana R. Lopez Quinones, MD

Attending Physician
Jacobi Medical Center - NYCHHC, New York

Disclosure information not submitted.
JM

Joaquin Morante, MD

Attending Physician
Jacobi Medical Center

Disclosure information not submitted.
MG

Michael Grushko, MD

Attending Physician
Jacobi Medical Center

Disclosure information not submitted.
EC

Edward R. Chao, MD, FACS

Attending Surgeon
Jacobi Medical Center, New York

Disclosure information not submitted.
JK

Jody Kaban, MD

Attending Surgeon
Jacobi Medical Center

Disclosure information not submitted.
ML

Matthew R. Langston, MD

Attending Physician
Jacobi Medical Center - NYCHHC, New York

Disclosure information not submitted.
SS

Seth Sokol, MD

Attending Physician
Jacobi Medical Center

Disclosure information not submitted.
AL

Anna R. Liveris, MD, FACS

Attending Surgeon, Director of Trauma and Surgical Research
Jacobi Medical Center - NYCHHC

Disclosure information not submitted.

Introduction: Severe burns with concomitant inhalational injury requiring VV-ECMO present a challenge for intensivists in balancing anticoagulation with bleeding risk both due to injury and serial operative debridement. Here we present a case series of our institutional experience.

Description: We describe 4 consecutive patients presenting with extensive >20% TBSA burns and concomitant inhalational injury who required VV-ECMO and required changes to their anticoagulation strategy. All patients were intubated at presentation and 2 patients underwent hyperbaric oxygen therapy. None had infectious complications. Anticoagulation was maintained within the therapeutic window unless otherwise specified. All 4 patients were successfully decannulated and survived to discharge with good functional outcomes off all vent support.

Discussion: Patient 1 suffered 35% TBSA burns and was on ECMO for 10 days. He was started on heparin and this was intermittently held for thrombocytopenia. He had recurrent bleeding from the nares and cannulas requiring 8u RBC and 5u platelets. All debridement was deferred until patient was decannulated. Patient 2 had 60% TBSA burns and was on ECMO for 6 days. He was initially started on heparin and transitioned to bivalirudin due to heparin resistance. He underwent tracheostomy and 2 operative debridements with substantial blood loss requiring 10u RBC and 2u FFP on ECMO. Patient 3 had 60% TBSA burns and was on ECMO for 7 days during which all operative debridement was deferred. He required 6u RBC for mucosal and line-associated bleeding. Patient 4 suffered 20% TBSA burns and was on circuit for 9 days. On ECMO day 2, he developed substantial airway bleeding. Heparin was discontinued and 14u RBC, 5u FFP, and 6u platelets were given. The oxygenator was exchanged due to clotting on ECMO day 6. The ECMO course was complicated by line-associated thrombosis and multiple intracranial hemorrhagic foci. Notably, bleeding risk appeared unrelated to %TBSA and operative debridement, with oxygenator change contributing to the highest transfusion rates. These cases suggest ECMO is safe with individualized risk assessment. More study is needed to establish best practice for anticoagulation and perioperative management in burn patients on ECMO.