“…Some have suggested that planned invasive procedures (e.g., percutaneous tracheostomy) should be performed in the early procoagulant phase, preferably in the first 48-72 hours of the ECMO run, especially in patients with early evidence of CAC. 26 However, evidence for this is lacking. In the case of necessary emergency procedures, the increased risk of bleeding and its effect on outcomes must be strongly considered when making a risk-to-benefit judgment, especially in patients who are late into their ECMO support.…”