Thromboembolic and Bleeding Events in COVID-19 Patients receiving Extracorporeal Membrane Oxygenation.

Abstract

BACKGROUND:

Extracorporeal membrane oxygenation (ECMO) is a potential treatment option in critically ill COVID-19 patients suffering from acute respiratory distress syndrome (ARDS) if mechanical ventilation (MV) is insufficient; however, thromboembolic and bleeding events (TEBE) during ECMO treatment still need to be investigated.

METHODS:

We conducted a retrospective, single-center study including COVID-19 patients treated with ECMO. Additionally, we performed a univariate analysis of 85 pre-ECMO variables to identify factors influencing incidences of thromboembolic events (TEE) and bleeding events (BE), respectively.

RESULTS:

Seventeen patients were included; the median age was 57 years (interquartile range [IQR]: 51.5-62), 11 patients were males (65%), median ECMO duration was 16 days (IQR: 10.5-22), and the overall survival was 53%. Twelve patients (71%) developed TEBE. We observed 7 patients (41%) who developed TEE and 10 patients (59%) with BE. Upper respiratory tract (URT) bleeding was the most frequent BE with eight cases (47%). Regarding TEE, pulmonary artery embolism (PAE) had the highest incidence with five cases (29%). The comparison of diverse pre-ECMO variables between patients with and without TEBE detected one statistically significant value. The platelet count was significantly lower in the BE group (n = 10) than in the non-BE group (n = 7) with 209 (IQR: 145-238) versus 452 G/L (IQR: 240-560), with p = 0.007.

CONCLUSION:

This study describes the incidences of TEE and BE in critically ill COVID-19 patients treated with ECMO. The most common adverse event during ECMO support was bleeding, which occurred at a comparable rate to non-COVID-19 patients treated with ECMO.

• Authors: Koray Durak, Alexander Kersten, Oliver Grottke, Rashad Zayat, Michael Dreher, Rüdiger Autschbach, Gernot Marx, Nikolaus Marx, Jan Spillner, Sebastian Kalverkamp
• Journal: The Thoracic and cardiovascular surgeon (Thorac Cardiovasc Surg) Vol. 69 Issue 6 Pg. 526-536 (09 2021) ISSN: 1439-1902 [Electronic] Germany
• PMID: 33862633 (Publication Type: Journal Article, Observational Study)
• Copyright: Thieme. All rights reserved.

Topics

• Aged
• COVID-19 (diagnosis, epidemiology, therapy)
• Critical Illness
• Extracorporeal Membrane Oxygenation (adverse effects)
• Female
• Germany (epidemiology)
• Hemorrhage (diagnosis, epidemiology)
• Humans
• Incidence
• Male
• Middle Aged
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Thromboembolism (diagnosis, epidemiology)
• Treatment Outcome