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13.07.2022 | COVID-19 | Original

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

verfasst von: Alexandre Mansour, Erwan Flecher, Matthieu Schmidt, Bertrand Rozec, Isabelle Gouin-Thibault, Maxime Esvan, Claire Fougerou, Bruno Levy, Alizée Porto, James T. Ross, Marylou Para, Sabrina Manganiello, Guillaume Lebreton, André Vincentelli, Nicolas Nesseler, on behalf of the ECMOSARS Investigators

Erschienen in: Intensive Care Medicine | Ausgabe 8/2022

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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 in-hospital 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 (adjOR = 13.5[4.4–41.5]). 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.

Conclusions

In a nationwide cohort of COVID-19 patients supported by ECMO, bleeding incidence was high and associated with mortality. Intracranial hemorrhage incidence was higher than reported for non-COVID patients and carried the highest risk of death. Thrombotic events were less frequent and not associated with mortality. Length of ECMO support was associated with a higher risk of both bleeding and thrombosis, supporting the development of strategies to minimize ECMO duration.

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Titel: Bleeding and thrombotic events in patients with severe COVID-19 supported with extracorporeal membrane oxygenation: a nationwide cohort study
verfasst von: Alexandre Mansour
Erwan Flecher
Matthieu Schmidt
Bertrand Rozec
Isabelle Gouin-Thibault
Maxime Esvan
Claire Fougerou
Bruno Levy
Alizée Porto
James T. Ross
Marylou Para
Sabrina Manganiello
Guillaume Lebreton
André Vincentelli
Nicolas Nesseler
on behalf of the ECMOSARS Investigators
Publikationsdatum: 13.07.2022
Verlag: Springer Berlin Heidelberg
Schlagwort: COVID-19
Erschienen in: Intensive Care Medicine / Ausgabe 8/2022
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-022-06794-y

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

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