Bleeding and Thrombotic Complications in COVID-19-Associated ARDS Requiring ECMO

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Eduardo P Tavares1, José R Rebolo2, Rodrigo Pimentel2

  • 1Faculty of Medicine of Porto, Porto, Portugal.

Respiratory Care
|November 15, 2022
PubMed

Insights

Patients with COVID-19-associated Acute Respiratory Distress Syndrome (ARDS) requiring extracorporeal membrane oxygenation (ECMO) experienced more severe bleeding complications and longer treatment durations compared to other ARDS causes. Further research is needed to assess ECMO

Area of Science:

  • Critical Care Medicine
  • Pulmonology
  • Infectious Diseases

Background:

  • Acute Respiratory Distress Syndrome (ARDS) is a severe lung condition.
  • Extracorporeal Membrane Oxygenation (ECMO) is a life support treatment for severe ARDS.
  • COVID-19 has been associated with a unique ARDS presentation.

Purpose of the Study:

  • To compare bleeding and thrombotic complications in COVID-19-associated ARDS versus other causes of ARDS requiring ECMO.
  • To analyze clinical outcomes and ECMO course in COVID-19 ARDS patients.

Main Methods:

  • A single-center observational study included adult patients undergoing ECMO for COVID-19 ARDS (n=67) or other ARDS (n=60).
  • Exclusion criteria included trauma patients.
  • Data on complications, laboratory values, and clinical outcomes were collected and compared.

Main Results:

  • COVID-19 ARDS patients had lower invasive mechanical ventilation duration before ECMO and less frequent ECMO retrieval.
  • Despite similar thrombotic complications and predicted survival scores, COVID-19 ARDS showed higher rates of severe bleeding (airway bleeding, hemothorax), lower hemoglobin, and increased red blood cell transfusions.
  • COVID-19 ARDS was associated with significantly longer ECMO duration (47 days vs 19 days) but no significant difference in in-hospital mortality.

Conclusions:

  • COVID-19-associated ARDS requiring ECMO is characterized by a high incidence of severe bleeding complications and prolonged treatment duration.
  • Further investigation is warranted to fully understand the risks and benefits of ECMO in severe COVID-19 ARDS.
  • Clinical management strategies may need to be adapted for COVID-19 ARDS patients on ECMO, particularly regarding bleeding risk.
Abstract

Keywords:
ARDSCOVID-19bleedingextracorporeal membrane oxygenationthrombosis

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