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Increased Intracranial Hemorrhage Amid Elevated Inflammatory Markers in Those With COVID-19 Supported With

Rene S Bermea1, Yuval Raz1, Federico Sertic2

  • 1Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

Shock (Augusta, Ga.)
|February 15, 2021
PubMed

Insights

Patients with COVID-19 on extracorporeal membrane oxygenation (ECMO) experienced a high incidence of intracranial hemorrhage (ICH). COVID-19 patients had lower ICH-free survival compared to those with other viral respiratory infections.

Area of Science:

  • Critical Care Medicine
  • Neurology
  • Infectious Diseases

Background:

  • COVID-19 is associated with coagulopathy, increasing risks during extracorporeal membrane oxygenation (ECMO).
  • Intracranial hemorrhage (ICH) is a severe complication in patients requiring ECMO for acute respiratory distress syndrome (ARDS).

Purpose of the Study:

  • To evaluate the incidence and etiology of ICH in COVID-19 patients undergoing ECMO.
  • To compare ICH rates and outcomes in COVID-19 patients versus those with other viral ARDS on ECMO.

Main Methods:

  • Retrospective analysis of 33 COVID-19 patients requiring venovenous-ECMO for ARDS at two academic medical centers.
  • Evaluation of patient demographics, clinical data, inflammatory markers, anticoagulation status, and outcomes, including ICH occurrence.

Main Results:

  • Eleven out of 33 (33.3%) COVID-19 patients developed ICH, all while receiving intravenous anticoagulation.
  • ICH patients exhibited higher C-reactive protein, procalcitonin, IL-6 levels, lower blood pH, and higher activated partial thromboplastin times.
  • ICH-free survival was significantly lower in COVID-19 patients (49%) compared to non-COVID-19 ARDS patients on ECMO (79%).

Conclusions:

  • COVID-19 patients can be successfully supported with ECMO, but face a higher risk of ICH.
  • Elevated inflammatory markers and anticoagulation are associated with ICH in COVID-19 patients on ECMO.
  • Strategies to mitigate ICH risk are crucial for improving outcomes in critically ill COVID-19 patients requiring ECMO.

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