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    Impact of major bleeding and thrombosis on 180-day survival in patients with severe COVID-19 supported with veno-venous extracorporeal membrane oxygenation in the United Kingdom: a multicentre observational study

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    Author
    Isgro, Graziella
    Yusuff, Hakeem
    Keyword
    COVID-19
    bleeding
    extracorporeal membrane oxygenation
    mortality
    thrombosis
    Date
    2022-02
    
    Metadata
    Show full item record
    Publisher's URL
    https://onlinelibrary.wiley.com/doi/10.1111/bjh.17870
    Abstract
    Bleeding and thrombosis are major complications in patients supported with extracorporeal membrane oxygenation (ECMO). In this multicentre observational study of 152 consecutive patients (≥18 years) with severe COVID-19 supported by veno-venous (VV) ECMO in four UK commissioned centres during the first wave of the COVID-19 pandemic (1 March to 31 May 2020), we assessed the incidence of major bleeding and thrombosis and their association with 180-day mortality. Median age (range) was 47 years (23-65) and 75% were male. Overall, the 180-day survival was 70·4% (107/152). The rate of major bleeding was 30·9% (47/152), of which intracranial bleeding (ICH) was 34% (16/47). There were 96 thrombotic events (63·1%) consisting of venous 44·7% [68/152 of which 66·2% were pulmonary embolism (PE)], arterial 18·6% (13/152) and ECMO circuit thrombosis 9·9% (15/152). In multivariate analysis, only raised lactate dehydrogenase (LDH) at the initiation of VV ECMO was associated with an increased risk of thrombosis [hazard ratio (HR) 1·92, 95% CI 1·21-3·03]. Major bleeding and ICH were associated with 3·87-fold (95% CI 2·10-7·23) and 5·97-fold [95% confidence interval (CI) 2·36-15·04] increased risk of mortality and PE with a 2·00-fold (95% CI1·09-3·56) risk of mortality. This highlights the difficult balancing act often encountered when managing coagulopathy in COVID-19 patients supported with ECMO.
    Citation
    Arachchillage, D. J., Rajakaruna, I., Scott, I., Gaspar, M., Odho, Z., Banya, W., Vlachou, A., Isgro, G., Cagova, L., Wade, J., Fleming, L., Laffan, M., Szydlo, R., Ledot, S., Jooste, R., Vuylsteke, A., & Yusuff, H. (2022). Impact of major bleeding and thrombosis on 180-day survival in patients with severe COVID-19 supported with veno-venous extracorporeal membrane oxygenation in the United Kingdom: a multicentre observational study. British journal of haematology, 196(3), 566–576. https://doi.org/10.1111/bjh.17870
    Type
    Article
    URI
    http://hdl.handle.net/20.500.12904/15172
    Collections
    Haematology
    Infectious Diseases
    Intensive Care

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