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01-02-2022 | Stroke | Original

Bleeding and thrombotic events in adults supported with venovenous extracorporeal membrane oxygenation: an ELSO registry analysis

Authors: Jose I. Nunez, Andre F. Gosling, Brian O’Gara, Kevin F. Kennedy, Peter Rycus, Darryl Abrams, Daniel Brodie, Shahzad Shaefi, A. Reshad Garan, E. Wilson Grandin

Published in: Intensive Care Medicine | Issue 2/2022

Abstract

Purpose

This study aimed at analyzing the prevalence, mortality association, and risk factors for bleeding and thrombosis events (BTEs) among adults supported with venovenous extracorporeal membrane oxygenation (VV-ECMO).

Methods

We queried the Extracorporeal Life Support Organization registry for adults supported with VV-ECMO from 2010 to 2017. Multivariable logistic regression modeling was used to assess the association between BTEs and in-hospital mortality and the predictors of BTEs.

Results

Among 7579 VV-ECMO patients meeting criteria, 40.2% experienced ≥ 1 BTE. Thrombotic events comprised 54.9% of all BTEs and were predominantly ECMO circuit thrombosis. BTE rates decreased significantly over the study period (p < 0.001). The inpatient mortality rate was 34.9%. Bleeding events (1.69 [1.49–1.93]) were more strongly associated with in-hospital mortality than thrombotic events (1.23 [1.08–1.41]) p < 0.01 for both. The BTEs most strongly associated with mortality were ischemic stroke (4.50 [2.55–7.97]) and medical bleeding, including intracranial (5.71 [4.02–8.09]), pulmonary (2.02 [1.54–2.67]), and gastrointestinal (1.54 [1.2–1.98]) hemorrhage, all p < 0.01. Risk factors for bleeding included acute kidney injury and pre-ECMO vasopressor support and for thrombosis were higher weight, multisite cannulation, pre-ECMO arrest, and higher PaCO₂ at ECMO initiation. Longer time on ECMO, younger age, higher pH, and earlier year of support were associated with bleeding and thrombosis.

Conclusions

Although decreasing over time, BTEs remain common during VV-ECMO and have a strong, cumulative association with in-hospital mortality. Thrombotic events are more frequent, but bleeding carries a higher risk of inpatient mortality. Differential risk factors for bleeding and thrombotic complications exist, raising the possibility of a tailored approach to VV-ECMO management.

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Title: Bleeding and thrombotic events in adults supported with venovenous extracorporeal membrane oxygenation: an ELSO registry analysis
Authors: Jose I. Nunez
Andre F. Gosling
Brian O’Gara
Kevin F. Kennedy
Peter Rycus
Darryl Abrams
Daniel Brodie
Shahzad Shaefi
A. Reshad Garan
E. Wilson Grandin
Publication date: 01-02-2022
Publisher: Springer Berlin Heidelberg
Keywords: Stroke
Acute Kidney Injury
Thrombosis
Acute Kidney Injury
ECMO
ECMO
Published in: Intensive Care Medicine / Issue 2/2022
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-021-06593-x

At a glance: The ONWARDS insulin icodec trials

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Bleeding and thrombotic events in adults supported with venovenous extracorporeal membrane oxygenation: an ELSO registry analysis

Abstract

Purpose

Methods

Results

Conclusions

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Springer Medicine

Abstract

Purpose

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