Although uncommon, oxygenator thrombosis in extra-corporeal membrane oxygenation (ECMO) devicesremains a potential reason for exchanging the circuit,the risk of thrombosis increases with the duration ofECMO therapy and with procoagulant conditions, suchas COVID-19 [1, 2]. With a worldwide increased demandfor ECMO support, alternative methods to prolong lifes-pan of the oxygenator have been considered. Recombi-nant tissue-type plasminogen activator (rtPA) could be apotential approach in this setting [3].From March 1, 2020, to March 30, 2022, 3 patients froma population of 99 were treated with either veno-arterial(V-A) and veno-venous (V-V) ECMO or extra-corporealCO2 removal (ECCO2R) support in our Intensive CareUnit (ICU) required the injection of rtPA for acute oxy-genator thrombosis. Characteristics of the study cohortare reported in Table 1. Informed consent was waived byour Ethics Committee because the data collection wasretrospective from the data patient monitoring system(PDMS). The decision to administer rtPA was discussedand decided in the multidisciplinary medical round.