Extracorporeal membrane oxygenation ECMO was widely utilized during the coronavirus disease COVID-19 pandemic. ECMO provision in Saudi Arabia has shown notable improvement; however, a considerable increase in the demand for the services regionally and globally. The national Ministry Of Health MOH ECMO program was started during the COVID-19 pandemic and aimed to organize and centralize the ECMO service all over Saudi Arabia to cope with the kingdom's vision. The program has different tasks, including lifesaving ECMO transportation during the time of surge to specialized ECMO centers through the ministry of health 1937 hotline life-saving call center. In this review article, we aimed to highlight the feasibility of launching a new national centralized ECMO program for proper control of resources during the pandemic and operational management challenges.

Extracorporeal membrane oxygenation (ECMO) has been used increasingly for both respiratory and cardiac failure in adult patients. The patients requiring ECMO are at increased risk of developing significant coagulopathy. The exposure of a patient's blood to the artificial surface of the ECMO circuit results in the activation of the coagulation-fibrinolysis system and an inflammatory response. During ECMO, anticoagulation is required to prevent thrombotic complications, and unfractionated heparin (UFH) remains the predominant anticoagulation agent used to minimize the potentially life-threatening complications related to bleeding events or thromboembolic complications. Most centers adjust UFH by activated clotting time (ACT) of 140–180 sec or partial thromboplastin time (PTT) of 40–80 s. In this article, we will review thromboelastometry use during ECMO in ICU.

The management of critically ill patients with burns is challenging. Despite recent advances in the management of burns, morbidity and mortality remain high. The indications and applications of extracorporeal life support have expanded in recent years. Here, we discuss the rationale for the use of extracorporeal life support for major burns with emphasis on currently available evidence.

Pulmonary arterial hypertension (PAH) in neonates, infants, and with congenital heart diseases (CHDs) is challenging in diagnosis and management with many risk factors. Pulmonary hypertension (PH) may present intraoperatively with failure of weaning cardiopulmonary bypass with increased mean pulmonary pressure to systemic or supra-systemic where time is limited to manage it. We described six cases with VA-ECMO deployment as a bridge of PH Management to reach optimal conservative therapy that was started immediately. The overall survival was 83%.

Anticoagulation in extracorporeal membrane oxygenation (ECMO) can be one of the obstacles in starting and managing patients with refractory hypoxemia, especially with diffuse alveolar hemorrhage (DAH). In this case report, we describe our experience with a 21-year-old male patient who presented with DAH and refractory hypoxemia secondary to systemic lupus erythematosus and was anticoagulated safely during ECMO to maintain circuit integrity, as a bridge to immunosuppressive therapy until he was decannulated successfully. Thromboelastography played a major role in our case management to guide our anticoagulation intensity.