Thrombotic circuit complications during venovenous extracorporeal membrane oxygenation in COVID-19

Abstract

The novel coronavirus SARS-CoV-2 and the resulting disease COVID-19 causes pulmonary failure including severe courses requiring venovenous extracorporeal membrane oxygenation (V-V ECMO). Coagulopathy is a known complication of COVID-19 leading to thrombotic events including pulmonary embolism. It is unclear if the coagulopathy also increases thrombotic circuit complications of the ECMO. Aim of the present study therefor was to investigate the rate of V-V ECMO complications in COVID-19. We conducted a retrospective registry study including all patients on V-V ECMO treated at our centre between 01/2018 and 04/2020. COVID-19 cases were compared non-COVID-19 cases. All circuit related complications resulting in partial or complete exchange of the extracorporeal system were registered. In total, 66 patients were analysed of which 11 (16.7%) were SARS-CoV-2 positive. The two groups did not differ in clinical parameters including age (COVID-19 59.4 vs. non-COVID-19 58.1 years), gender (36.4% vs. 40%), BMI (27.8 vs. 24.2) and severity of illness as quantified by the RESP Score (1pt. vs 1pt.). 28 days survival was similar in both groups (72.7% vs. 58.2%). While anticoagulation was similar in both groups (p = 0.09), centrifugal pump head thrombosis was more frequent in COVID-19 (9/11 versus 16/55 p < 0.01). Neither the time to first exchange (p = 0.61) nor blood flow at exchange (p = 0.68) did differ in both groups. D-dimer levels prior to the thrombotic events were significantly higher in COVID-19 (mean 15.48 vs 26.59, p = 0.01). The SARS-CoV-2 induced infection is associated with higher rates of thrombotic events of the extracorporeal system during V-V ECMO therapy. Keyword V-V ECMO • COVID-19 • Thrombotic complications • Pump head thrombosis Abbreviations aPTT Activated partial thromboplastin time ARDS Acute respiratory distress syndrome COVID-19 Coronavirus disease 2019 ICU Intensive care unit SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 V-V ECMO Venovenous extracorporeal membrane oxygenation Highlights • This study compared the rate of thrombotic circuit complications in COVID-19 V-V ECMO patients to historical controls. • The two groups were comparable.

Intracerebral Hemorrhage in COVID-19 Patients with Pulmonary Failure: A Propensity Score-Matched Registry Study

“…Some phenotypes of pulmonary failure proceed with a hyperinflammatory immune response, circulatory failure, and subsequent multi-organ failure. The underlying hypercoagulability results in clinical complications pronounced in COVID-19 ARDS, such as deep vein thrombosis, pulmonary artery thrombosis, or clotting during extracorporeal organ replacement therapies [ 10 , 25 ]. The detection of a high rate of new strokes (11.0%) in the cohort, mainly due to embolic events, might also be an expression of inflammation-induced hypercoagulability.…”

Cytokine adsorption in a patient with severe coronavirus disease 2019 related acute respiratory distress syndrome requiring extracorporeal membrane oxygenation therapy: A case report

“…While cytokine adsorption was effective and seemed to support stabilization of the patient, we observed severe clotting in the ECMO circuit even under full anticoagulation therapy as a serious therapeutic challenge. Hypercoagulability in COVID‐19 has been described previously, and therefore, this complication is most probably not a consequence of cytokine adsorption or ECMO, but rather explained by the underlying disease 16,17 …”

D-Dimer-Driven Anticoagulation Reduces Mortality in Intubated COVID-19 Patients: A Cohort Study With a Propensity-Matched Analysis

“…Deep vein thrombosis (DVT) ( 1 ), pulmonary embolism (PE) ( 2 , 3 ), cerebral infarction ( 4 ), and myocardial infarction (MI) ( 5 , 6 ) have all been reported in patients severely ill because of COVID-19 ( 7 – 9 ). Additionally, vascular access including dialysis catheters ( 10 ) and extracorporeal membrane oxygenation (ECMO) circuits ( 11 ) also fail at higher rates. D-dimer levels, a marker of fibrin breakdown ( 12 ) and intravascular clot burden ( 13 ), are increased in many patients with COVID-19.…”