학술논문
Hemorrhage and thrombosis in COVID-19-patients supported with extracorporeal membrane oxygenation: an international study based on the COVID-19 critical care consortium
Document Type
Report
Author
Feth, Maximilian; Weaver, Natasha; Fanning, Robert B.; Cho, Sung-Min; Griffee, Matthew J.; Panigada, Mauro; Zaaqoq, Akram M.; Labib, Ahmed; Whitman, Glenn J. R.; Arora, Rakesh C.; Kim, Bo S.; White, Nicole; Suen, Jacky Y.; Li Bassi, Gianluigi; Peek, Giles J.; Lorusso, Roberto; Dalton, Heidi; Fraser, John F.; Fanning, Jonathon P.; Bassi, Gianluigi Li; Dalton, Heidi J.; Laffey, John; Brodie, Daniel; Fan, Eddy; Torres, Antoni; Chiumello, Davide; Elhazmi, Alyaa; Hodgson, Carol; Ichiba, Shingo; Luna, Carlos; Murthy, Srinivas; Nichol, Alistair; Ng, Pauline Yeung; Ogino, Mark; Marwali, Eva; Grasselli, Giacomo; Bartlett, Robert; Burrell, Aidan; Elhadi, Muhammed; Motos, Anna; Barbé, Ferran; Zanella, Alberto
Source
Journal of Intensive Care. May 6, 2024, Vol. 12 Issue 1
Subject
Language
English
ISSN
2052-0492
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). Keywords: Coagulation disorders, COVID-19, Extracorporeal membrane oxygenation, Bleeding events, Thrombotic events
Author(s): Maximilian Feth[sup.1], Natasha Weaver[sup.2,3], Robert B. Fanning[sup.4,5], Sung-Min Cho[sup.6,7], Matthew J. Griffee[sup.8,9], Mauro Panigada[sup.10], Akram M. Zaaqoq[sup.11], Ahmed Labib[sup.12], Glenn J. R. Whitman[sup.6], Rakesh C. Arora[sup.13,14], Bo S. Kim[sup.6], [...]
Author(s): Maximilian Feth[sup.1], Natasha Weaver[sup.2,3], Robert B. Fanning[sup.4,5], Sung-Min Cho[sup.6,7], Matthew J. Griffee[sup.8,9], Mauro Panigada[sup.10], Akram M. Zaaqoq[sup.11], Ahmed Labib[sup.12], Glenn J. R. Whitman[sup.6], Rakesh C. Arora[sup.13,14], Bo S. Kim[sup.6], [...]