Open thoracoabdominal aortic aneurysm repair (TAAAR) is associated with mortality rates of between 8% and 25%. One of the characteristics of TAAAR is massive bleeding that requires multiple units of blood, plasma and platelets. Following the development of endovascular techniques, open surgery is now reserved for more complex cases, such as collagenopathy diseases or failure of previous endovascular repair. These surgeries carry an even higher risk of bleeding.

We present 4 cases in which veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and cardiotomy suction were used. In VA-ECMO, we used heparin 100 units/kg to achieve an activated clotting time of up to 250 s. At the end of the procedure, 1 mg of protamine was administered for every 100 units of heparin. This strategy has the advantage of preventing the loss of fibrinogen, coagulation factors and platelets in the blood processed from the cell saver.

The use of a cardiotomy reservoir with VA-ECMO may help optimise intraoperative patient blood management and reduce the incidence of coagulopathy during TAAAR.