BMC anesthesiology · 2025
Outcome of patients with COVID-19 supported by veno-venous extracorporeal membrane oxygenation with major bleeding: a single centre experience.
СтатьяНазвание и аннотация: Перевод в очереди
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Dubler Simon, Kowarik Michael, Budeus Bettina, Habanik Tomas, Zwanziger Denise, Skarabis Annabell, Espeter Florian, Brenner Thorsten, Herbstreit Frank
Аннотация
BACKGROUND: Patients with severe COVID-19 often require veno-venous extracorporeal membrane oxygenation (VV-ECMO) due to acute respiratory distress syndrome (ARDS). Major bleeding complications are common and linked to worse outcomes, though specific risk factors in COVID-19 remain unclear.
METHODS: A retrospective analysis of 151 critically ill patients with COVID-19 on VV-ECMO (March 2020-December 2021) was conducted. The primary outcome was major bleeding (fatal bleeding, haemoglobin drop ≥ 20 g/L-1 (1.24 mmol/L-1), or symptomatic bleeding in critical organs). Secondary outcomes included 90-day mortality, kidney replacement therapy, and disease severity.
RESULTS: Major bleeding occurred in 73/151 patients (48.3%). Only a longer ECMO duration [OR 1.32 (95% CI 1.14-1.53; p < 0.001)] was identified as an independent risk factor. Kidney replacement therapy independently influenced 90-day mortality [OR 4.48 (95% CI 1.83-10.98;p = 0.001). However, major bleeding, intracranial haemorrhage, higher burden of co-morbidity and mean aPTT before major bleeding were not associated with an increased 90-day mortality risk.
CONCLUSION: Major bleeding events, including intracranial haemorrhage, are common in patients with COVID-19 being supported by VV-ECMO. However, our data does not demonstrate a direct association between major bleeding and increased 90-day mortality.
METHODS: A retrospective analysis of 151 critically ill patients with COVID-19 on VV-ECMO (March 2020-December 2021) was conducted. The primary outcome was major bleeding (fatal bleeding, haemoglobin drop ≥ 20 g/L-1 (1.24 mmol/L-1), or symptomatic bleeding in critical organs). Secondary outcomes included 90-day mortality, kidney replacement therapy, and disease severity.
RESULTS: Major bleeding occurred in 73/151 patients (48.3%). Only a longer ECMO duration [OR 1.32 (95% CI 1.14-1.53; p < 0.001)] was identified as an independent risk factor. Kidney replacement therapy independently influenced 90-day mortality [OR 4.48 (95% CI 1.83-10.98;p = 0.001). However, major bleeding, intracranial haemorrhage, higher burden of co-morbidity and mean aPTT before major bleeding were not associated with an increased 90-day mortality risk.
CONCLUSION: Major bleeding events, including intracranial haemorrhage, are common in patients with COVID-19 being supported by VV-ECMO. However, our data does not demonstrate a direct association between major bleeding and increased 90-day mortality.