A role for nebulized tranexamic acid in veno‐venous ECMO patients

What is known and objective Although pulmonary haemorrhage as a complication of ECMO has been well documented, optimal management is not fully elucidated. We describe the role of nebulized tranexamic acid as a therapeutic alternative. Case summary We report a case series of three patients with ARDS on ECMO complicated by pulmonary haemorrhage. These patients were treated with 500 mg of nebulized tranexamic acid via the endotracheal tube. Key observations included significant stabilization of haemodynamics, reduced circuit changes and less time off of anticoagulation. What is new and conclusion This series demonstrates successful bleeding management with nebulized tranexamic acid, reducing the frequency of ECMO circuit changes, time off of anticoagulation and blood loss. We describe the role of nebulized tranexamic acid as a therapeutic alternative for pulmonary haemorrhage as a complication of ECMO, with successful bleeding management, while reducing the frequency of ECMO circuit changes, and time off of anticoagulation..