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

Abstract

Purpose: To describe bleeding and thrombotic events and their risk factors in patients receiving extracorporeal membrane oxygenation (ECMO) for severe coronavirus disease 2019 (COVID-19) and to evaluate their impact on inhospital mortality. Methods:The ECMOSARS registry included COVID-19 patients supported by ECMO in France. We analyzed all patients included up to March 31, 2022 without missing data regarding bleeding and thrombotic events. The association of bleeding and thrombotic events with in-hospital mortality and pre-ECMO variables was assessed using multivariable logistic regression models.Results: Among 620 patients supported by ECMO, 29% had only bleeding events, 16% only thrombotic events and 20% both bleeding and thrombosis. Cannulation site (18% of patients), ear nose and throat (12%), pulmonary bleeding (9%) and intracranial hemorrhage (8%) were the most frequent bleeding types. Device-related thrombosis and pulmonary embolism/thrombosis accounted for most of thrombotic events. In-hospital mortality was 55.7%. Bleeding events were associated with in-hospital mortality (adjusted odds ratio (adjOR) = 2. 91[1.94-4.4]) but not thrombotic events (adjOR = 1. 02[0.68-1.53]). Intracranial hemorrhage was strongly associated with in-hospital mortality ). Ventilation duration before ECMO ≥ 7 days and length of ECMO support were associated with bleeding. Thrombosis-associated factors were fibrinogen ≥ 6 g/L and length of ECMO support.

ECMO in Cardiogenic Shock: Time Course of Blood Biomarkers and Associated Mortality

“…Our multivariable model identified hemorrhage (HR 1.73, p = 0.005) during ECMO support as an independent risk factor for death, which is well-established in current literature [ 8 , 9 ]. Furthermore, this potentially lethal complication is independent of the type of ECMO configuration [ 4 , 6 , 21 ].…”

Extracorporeal membrane oxygenation in COVID-19 associated acute respiratory distress syndrome: A narrative review

“…[ 51 ] Recently, Mansour et al. [ 52 ] provided important insights regarding these complications in COVID-19 patients treated with ECMO. In a large, prospective, multicenter cohort study including 620 patients from February 2020 to March 2022, the incidence of bleeding was greater than that of thrombosis (49% vs. 36%).…”

The Role of VV-ECMO in Severe COVID-19 ARDS

“…Interestingly, the incidence of haemorrhagic complications was higher compared with the Study of the Treatment and Outcomes in Critically Ill Patients with COVID-19 (STOP-COVID), 28% vs. 40%, and also that of the ELSO registry study [47,57]. A follow-on ECMOSARS registry study by Mansour et al analysed all patients in this registry over the course of the first and second pandemic waves from February 2020 to the end of March 2022 [90]. In this review, 65.5% of patients experienced either bleeding or thrombosis.…”