In a nationwide cohort of COVID‑19 patients supported by extracorporeal membrane oxygenation (ECMO), bleeding incidence was high and associated with mortality.

Intracranial hemorrhage incidence was higher than reported for non‑COVID patients and carried the highest risk of death.

Thrombotic events were less frequent and not associated with mortality.

Length of ECMO support was associated with a higher risk of both bleeding and thrombosis, supporting the development of strategies to minimize ECMO duration.

Among 620 patients supported by ECMO, 29% had only bleeding events, 16% only thrombotic events and 20% both bleeding and thrombosis.

Cannulation site (18% of patients), ear nose and throat (12%), pulmonary bleed‑ ing (9%) and intracranial hemorrhage (8%) were the most frequent bleeding types.

Device‑related thrombosis and pulmonary embolism/thrombosis accounted for most of thrombotic events.

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