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
dc.contributor.author | Isgro, Graziella | |
dc.contributor.author | Yusuff, Hakeem | |
dc.date.accessioned | 2022-02-04T16:49:40Z | |
dc.date.available | 2022-02-04T16:49:40Z | |
dc.date.issued | 2022-02 | |
dc.identifier.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 | en_US |
dc.identifier.other | 10.1111/bjh.17870 | |
dc.identifier.uri | http://hdl.handle.net/20.500.12904/15172 | |
dc.description.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. | |
dc.description.uri | https://onlinelibrary.wiley.com/doi/10.1111/bjh.17870 | en_US |
dc.language.iso | en | en_US |
dc.subject | COVID-19 | en_US |
dc.subject | bleeding | en_US |
dc.subject | extracorporeal membrane oxygenation | en_US |
dc.subject | mortality | en_US |
dc.subject | thrombosis | en_US |
dc.title | 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 | en_US |
dc.type | Article | en_US |
rioxxterms.funder | Default funder | en_US |
rioxxterms.identifier.project | Default project | en_US |
rioxxterms.version | NA | en_US |
rioxxterms.versionofrecord | https://doi.org/10.1111/bjh.17870 | en_US |
rioxxterms.type | Journal Article/Review | en_US |
refterms.panel | Unspecified | en_US |
refterms.dateFirstOnline | 2021-10 | |
html.description.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. | en_US |
rioxxterms.funder.project | 94a427429a5bcfef7dd04c33360d80cd | en_US |