Epidemiology of gastrointestinal bleeding in adult patients on extracorporeal life support

Mazzeffi, Michael; Kiefer, Jesse; Greenwood, John C.; Tanaka, Kenichi A.; Menaker, Jay; Kon, Zachary N.; Sánchez, Pablo G.; Pham, Si M.; Herr, Daniel

doi:10.1007/s00134-015-4006-8

Cited by 21 publications

(29 citation statements)

References 6 publications

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“…6 Patients with a bleeding diathesis, including those receiving extracorporeal life support, may have higher rates of overt bleeding, as reported in a study involving 132 such patients, 18 of whom had overt bleeding (13.6%). 20 By contrast, clinically important bleeding has hemodynamic consequences that may warrant red-cell transfusions or invasive interventions. 21,22 The pervasive impression is that clinically important upper gastrointestinal bleeding has declined over time because of advances in critical care practice; however, this postulate is not concordant with all the evidence.…”

Section: Critically Ill Patientsmentioning

confidence: 99%

Prophylaxis against Upper Gastrointestinal Bleeding in Hospitalized Patients

2018

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Section: Critically Ill Patientsmentioning

confidence: 99%

Prophylaxis against Upper Gastrointestinal Bleeding in Hospitalized Patients

2018

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“…27 Patients on ECMO support are a subset at increased risk of abdominal complications and GI bleeding for multifactorial reasons, like systemic anticoagulation and consumption coagulopathy, systemic inflammation, low platelet count, hypoxia, and low GI tract perfusion. 17,[28][29][30] In the case of acquired coagulopathy, such as consumption of von Willebrand factor, GI bleeding is often associated with diffuse bleeding without specific lesions. Furthermore, GI bleeding in ECMO patients, given the previous considerations, may be more severe and may be the cause of refractory anemia and hypovolemia.…”

Section: Discussionmentioning

confidence: 99%

“…[11][12][13][14][15][16] Among these complications, GI bleeding is a concrete challenge for ECMO teams, and it is likely that this is a neglected topic. 17 Therapeutic management of GI bleeding can be a challenge even for an experienced endoscopist, though several effective hemostatic techniques have been developed in recent years. In particular, management of profound venous or arterial bleeding and malignant lesions with large surface area are not frequently amenable to traditional endoscopic hemostatic techniques, especially in patients with impaired coagulation.…”

Section: Introductionmentioning

confidence: 99%

The role of endoscopy as non-invasive procedure to manage gastrointestinal complications during extracorporeal membrane oxygenation

et al. 2020

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Introduction: Gastrointestinal bleeding is a life-threatening complication in patients undergoing extracorporeal membrane oxygenation support. Despite data on increased mortality due to gastrointestinal bleeding, there is little data on the treatment of such conditions under extracorporeal membrane oxygenation, and on the possibilities of advanced endoscopic therapy to non-invasively solve these bleeding complications. No clear treatment in the case of extracorporeal membrane oxygenation support is recommended in the guidelines. Methods: Retrospective observational cohort study including 134 veno-venous extracorporeal membrane oxygenation patients for acute respiratory failure from 2009 to 2018 at IRCCS-ISMETT (Italy). Patients were divided into two groups according to gastrointestinal bleeding episodes and reviewed for type of endoscopic therapy. Gastrointestinal bleeding group was characterized for pre–extracorporeal membrane oxygenation characteristics, management variables—including amount of transfusions and clinical outcomes. Results: Fourteen (14) patients (10.4%) experienced upper (n = 13) or lower (n = 1) gastrointestinal bleeding. Gastrointestinal bleeding and no-gastrointestinal bleeding group had similar characteristics apart from higher creatinine in the gastrointestinal bleeding group (1.9 mg/dL (1.3-4.9) vs 1.2 mg/dL (0.7-1.8), p = 0.03). In 3 of the 14 patients (21%), endoscopy showed no signs of active bleeding (nasogastric or feeding tube decubitus), and no specific intervention was performed. Active bleeding was recognized in 11 of the 14 patients (79 %). No patients died of fatal bleeding in the gastrointestinal bleeding group. Endoscopic therapy was feasible, with a complete bleeding control in all the cases: five Hemospray®, two fibrin glue, two metallic clips, one combined approach metallic clips with epinephrine, and one cyanoacrylate. The extracorporeal membrane oxygenation course was significantly longer in the gastrointestinal bleeding group: 19.5 (15-36) days vs 13.5 (8-25) days, p = 0.01. No significant differences in mortality were found between the two groups (all p values > 0.05). Conclusion: Advanced endoscopic therapy during veno-venous extracorporeal membrane oxygenation may contribute to reducing the negative effects on mortality for gastrointestinal bleeding episodes.

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“…Older age, coagulation disorders due to multiple etiologies, and systemic disease all seem to alter blood flow with ECMO treatment, and these are considered to be risk factors for GI bleeding and are associated with increased mortality [ 8 , 9 ]. Most cases of GI hemorrhage in patients on ECMO are due to an upper-GI source of bleeding [ 10 , 11 ].…”

Section: Discussionmentioning

confidence: 99%