Hemorrhage and thrombosis in COVID-19-patients supported with extracorporeal membrane oxygenation: an international study based on the COVID-19 critical care consortium
Maximilian Feth, Natasha Weaver, Robert B. Fanning, Sung‐Min Cho, Matthew Griffee, Mauro Panigada, Akram Zaaqoq, Ahmed Labib, Glenn Whitman, Rakesh C. Arora, Bo Kim, Nicole White, Jacky Y. Suen, Gianluigi Li Bassi, Giles J. Peek, Roberto Lorusso, Heidi J. Dalton, John F. Fraser, Jonathon P. Fanning, Gianluigi Li Bassi, Jacky Y. Suen, Heidi J. Dalton, John G. Laffey, Daniel Brodie, Eddy Fan, Antoní Torres, Davide Chiumello, Alyaa Elhazmi, Carol Hodgson, Shingo Ichiba, Carlos M. Luna, Srinivas Murthy, Alistair Nichol, Pauline Yeung Ng, Mark Ogino, Eva Marwali, Giacomo Grasselli, Robert H. Bartlett, Aidan Burrell, Muhammed Elhadi, Ana Motos, Ferrán Barbé, Alberto Zanella, John F. Fraser
Abstract
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is a rescue therapy in patients with severe acute respiratory distress syndrome (ARDS) secondary to COVID-19. While bleeding and thrombosis complicate ECMO, these events may also occur secondary to COVID-19. Data regarding bleeding and thrombotic events in COVID-19 patients on ECMO are sparse. METHODS: Using the COVID-19 Critical Care Consortium database, we conducted a retrospective analysis on adult patients with severe COVID-19 requiring ECMO, including centers globally from 01/2020 to 06/2022, to determine the risk of ICU mortality associated with the occurrence of bleeding and clotting disorders. RESULTS: Among 1,248 COVID-19 patients receiving ECMO support in the registry, coagulation complications were reported in 469 cases (38%), among whom 252 (54%) experienced hemorrhagic complications, 165 (35%) thrombotic complications, and 52 (11%) both. The hazard ratio (HR) for Intensive Care Unit mortality was higher in those with hemorrhagic-only complications than those with neither complication (adjusted HR = 1.60, 95% CI 1.28-1.99, p < 0.001). Death was reported in 617 of the 1248 (49.4%) with multiorgan failure (n = 257 of 617 [42%]), followed by respiratory failure (n = 130 of 617 [21%]) and septic shock [n = 55 of 617 (8.9%)] the leading causes. CONCLUSIONS: Coagulation disorders are frequent in COVID-19 ARDS patients receiving ECMO. Bleeding events contribute substantially to mortality in this cohort. However, this risk may be lower than previously reported in single-nation studies or early case reports. Trial registration ACTRN12620000421932 ( https://covid19.cochrane.org/studies/crs-13513201 ).