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Thromboembolic and Bleeding Events in COVID-19 Patients receiving Extracorporeal Membrane Oxygenation
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.
+ Both authors contributed equally to this study.
Koray Durak has collected the data (60%), performed data Analysis (55%) and wrote the first version of the manuscript (100%). Alex Kersten contributed to the Study design (50%), performed ECMO implantation (35%), collected the data (40%), performed data analysis (45%), supervised the writing process of the first version of the manuscript, critically revised the manuscript. The above mentioned contribution justify a contributed equally authorship of both authors Koray Durak and Alex Kersten.
Received: 28 November 2020
Accepted: 18 January 2021
Article published online:
16 April 2021
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- 1 World Health Organization. Novel Coronavirus. Geneva: World Health Organization; 2020
- 2 Skevaki C, Fragkou PC, Cheng C, Xie M, Renz H. Laboratory characteristics of patients infected with the novel SARS-CoV-2 virus. J Infect 2020; 81 (02) 205-212
- 3 Driggin E, Madhavan MV, Bikdeli B. et al. Cardiovascular considerations for patients, health care workers, and health systems during the covid-19 pandemic. J Am Coll Cardiol 2020; 75 (18) 2352-2371
- 4 Klok FA, Kruip MJHA, van der Meer NJM. et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res 2020; 191: 145-147
- 5 Helms J, Tacquard C, Severac F. et al; CRICS TRIGGERSEP Group (Clinical Research in Intensive Care and Sepsis Trial Group for Global Evaluation and Research in Sepsis). High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med 2020; 46 (06) 1089-1098
- 6 Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 2020; 18 (04) 844-847
- 7 Cui S, Chen S, Li X, Liu S, Wang F. Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia. J Thromb Haemost 2020; 18 (06) 1421-1424
- 8 Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost 2020; 18 (05) 1094-1099
- 9 Marullo AG, Cavarretta E, Biondi Zoccai G. et al. Extracorporeal membrane oxygenation for critically ill patients with coronavirus-associated disease 2019: an updated perspective of the European experience. Minerva Cardioangiol 2020; 68 (05) 368-372
- 10 World Health Organization. Clinical management of COVID-19: interim guidance. Geneva: World Health Organization; 2020
- 11 Combes A, Hajage D, Capellier G. et al; EOLIA Trial Group, REVA, and ECMONet. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med 2018; 378 (21) 1965-1975
- 12 Mendes PV, Melro LMG, Li HY. et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome in adult patients: a systematic review and meta-analysis. Rev Bras Ter Intensiva 2019; 31 (04) 548-554
- 13 Munshi L, Walkey A, Goligher E, Pham T, Uleryk EM, Fan E. Venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis. Lancet Respir Med 2019; 7 (02) 163-172
- 14 Thomas J, Kostousov V, Teruya J. Bleeding and thrombotic complications in the use of extracorporeal membrane oxygenation. Semin Thromb Hemost 2018; 44 (01) 20-29
- 15 Jacobs JP, Stammers AH, St Louis J. et al. Extracorporeal membrane oxygenation in the treatment of severe pulmonary and cardiac compromise in coronavirus disease 2019: experience with 32 patients. ASAIO j 2020; 66 (07) 722-730
- 16 Kowalewski M, Fina D, Słomka A. et al. COVID-19 and ECMO: the interplay between coagulation and inflammation-a narrative review. Crit Care 2020; 24 (01) 205
- 17 Yang X, Cai S, Luo Y. et al. Extracorporeal membrane oxygenation for coronavirus disease 2019-induced acute respiratory distress syndrome: a multicenter descriptive study. Crit Care Med 2020; 48 (09) 1289-1295
- 18 Bartlett RH, Ogino MT, Brodie D. et al. Initial ELSO guidance document: ECMO for COVID-19 patients with severe cardiopulmonary failure. ASAIO J 2020; 66 (05) 472-474
- 19 Schulman S, Kearon C. Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost 2005; 3 (04) 692-694
- 20 Kon ZN, Smith DE, Chang SH. et al. Extracorporeal membrane oxygenation support in severe COVID-19. Ann Thorac Surg 2020
- 21 Loforte A, Dal Checco E, Gliozzi G. et al. Veno-venous extracorporeal membrane oxygenation support in COVID-19 respiratory distress syndrome: initial experience. ASAIO J 2020; 66 (07) 734-738
- 22 Peek GJ, Mugford M, Tiruvoipati R. et al; CESAR trial collaboration. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 2009; 374 (9698): 1351-1363
- 23 Yang X, Yu Y, Xu J. et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020; 8 (05) 475-481
- 24 Jiritano F, Serraino GF, Ten Cate H. et al. Platelets and extra-corporeal membrane oxygenation in adult patients: a systematic review and meta-analysis. Intensive Care Med 2020; 46 (06) 1154-1169
- 25 Extracorporeal Life Support Organization. Guidelines for Adult Respiratory Failure. Ann Arbor, MI: Extracorporeal Life Support Organization; 2017