Dynamic platelet dysfunction during extracorporeal membrane oxygenation: a pilot study.

Major bleeding complications are common in patients on extracorporeal membrane oxygenation (ECMO) with multiple underlying mechanisms and are associated with increased mortality. Dynamic platelet function changes during ECMO support remain incompletely understood and are underassessed in clinical practice. This study aimed to evaluate platelet function before, during, and after ECMO support and its association with major bleeding events. This prospective cohort study included adult ECMO patients with platelet counts over 100 × 109/L. Platelet aggregation function was assessed using the prolonged closure time in Collagen/Epinephrine (Col/Epi) and Collagen/Adenosine Diphosphate (Col/ADP) at four time points: before ECMO initiation (T0), 24 h (T1), 72 h (T2), and post-decannulation (T3). The primary outcome was major bleeding events, and the secondary outcome was the ICU mortality rate. A total of 36 eligible patients were enrolled from March 2023 to January 2025. Platelet dysfunction was observed in 36.1% at T0, increasing to 97.2% at T1 (p < 0.001), 97.2% at T2 (p < 0.001), and recovered post-decannulation. Major bleeding events occurred in 22.2% of patients. However, platelet dysfunction as measured by Col/Epi or Col/ADP did not significantly differ between patients with and without major bleeding events. A high incidence of platelet aggregation dysfunction was observed during ECMO support, with rapid recovery post-decannulation. However, the impact of platelet function during ECMO support on bleeding risk remains unclear. Further studies with larger sample sizes are needed to confirm these associations and improve bleeding risk management.