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COVID-19 virus disseminates throughout the body but the host response to this infection is variable. Inflammation and coagulation are essential host defense mechanisms that protect from infection. When unregulated these processes can lead to profound end organ injury. Anticoagulation remains a standard for Extracorporeal Membrane Oxygenation (ECMO) support. However, bleeding complications are highly comorbid in ECMO patients. For ECMO-supported COVID-19 patients, invasive procedures like tracheostomy may also be required. Invasive procedures can compound ongoing bleeding complications during ECMO treatment like airway bleeding. Although the etiology of airway bleeding is broad, major life-threatening complications may go unrecognized.