Abstract: Extracorporeal membrane oxygenation （ECMO） is an advanced life support modality for patients with respiratory or cardiac failure. During ECMO,various factors impair coagulation function,resulting in an imbalance between procoagulation and anticoagulation,thus increasing the incidence of bleeding and posing a significant challenge to the development of clinical work. In this article,the epidemiology,causes,anticoagulation and monitoring of high-risk bleeding during ECMO were reviewed,aiming to provide reference for clinical practice.