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Veno-Venous Extracorporeal Membrane Oxygenation in a Mouse

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Bleeding and thrombotic events in patients with severe COVID-19 supported with extracorporeal membrane oxygenation: a

Alexandre Mansour1,2,3, Erwan Flecher4, Matthieu Schmidt5,6

  • 1Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Rennes, France. alexandre.mansour@chu-rennes.fr.

Intensive Care Medicine
|July 13, 2022
PubMed

Insights

Bleeding events, particularly intracranial hemorrhage, were common and increased mortality in COVID-19 patients on extracorporeal membrane oxygenation (ECMO). Thrombotic events were less frequent and not linked to death, highlighting the need to minimize ECMO duration.

Area of Science:

  • Critical Care Medicine
  • Infectious Diseases
  • Cardiovascular Research

Background:

  • Severe coronavirus disease 2019 (COVID-19) often necessitates extracorporeal membrane oxygenation (ECMO) support.
  • Understanding bleeding and thrombotic complications during ECMO for COVID-19 is crucial for patient management.
  • Previous studies have indicated varied risks of these events in critically ill patients.

Purpose of the Study:

  • To characterize the incidence and types of bleeding and thrombotic events in COVID-19 patients undergoing ECMO.
  • To identify risk factors associated with these complications.
  • To evaluate the impact of bleeding and thrombotic events on in-hospital mortality.

Main Methods:

  • Analysis of data from the nationwide ECMOSARS registry in France, including COVID-19 patients on ECMO.
  • Inclusion of patients with complete data on bleeding and thrombotic events up to March 31, 2022.
  • Multivariable logistic regression models were used to assess associations with in-hospital mortality and pre-ECMO variables.

Main Results:

  • Among 620 ECMO patients, 29% experienced bleeding only, 16% thrombosis only, and 20% both.
  • Bleeding events, especially intracranial hemorrhage (adjOR=13.5), were significantly associated with in-hospital mortality (adjOR=2.91).
  • Thrombotic events were not associated with mortality (adjOR=1.02), while longer ECMO duration increased risks for both bleeding and thrombosis.

Conclusions:

  • High incidence of bleeding, particularly intracranial hemorrhage, in COVID-19 ECMO patients is linked to increased mortality.
  • Thrombotic events were less frequent and did not significantly impact mortality.
  • Minimizing ECMO duration is essential to reduce the risk of both bleeding and thrombotic complications.
Abstract

Keywords:
AnticoagulationBleedingCOVID-19ECMOThrombosis

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