Impact of Thrombosis and Bleeding in Patients with Severe COVID-19 versus Other Viral Pneumonias in the Context of Extracorporeal Membrane Oxygenation

Weatherill, Anna; Laffan, Michael; Gasper, Mihaela; Bianchi, Paolo; Passariello, Maurizio; Singh, Suveer; Doyle, James F.; Patel, Brijesh; Ledot, Stéphane; Garfield, Benjamin; Arachchillage, Deepa J.

doi:10.1055/s-0041-1732371

Cited by 8 publications

(20 citation statements)

References 11 publications

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“…Thrombosis incidence was lower than bleeding in our cohort, which contrasts with the recent ELSO report on VV-ECMO [12], even though our study included deep vein thrombosis and pulmonary embolism/thrombosis which are not recorded in the ELSO registry. Our results also differ from the high rates of thrombosis in early reports of COVID-19 patients on VV-ECMO [27,28,34]. Two factors might have influenced these results.…”

Section: Discussioncontrasting

confidence: 99%

“…Second, thrombosis reporting is highly dependent on clinical and radiological screening protocols. Systematic ultrasound or computed-tomography assessment of thrombosis on ECMO is likely accountable for the discrepancy between our results and recently published COVID-19 reports, especially regarding pulmonary embolism/thrombosis [27,28,34].…”

Section: Discussioncontrasting

confidence: 99%

“…Five hundred sixty-eight patients were supported by VV-ECMO, and 52 by VA-ECMO. Median age was 55 (47-61) years, 22.9% were females, and had a median body mass index of 30 (27)(28)(29)(30)(31)(32)(33)(34) kg/m 2 (Table 1). Median SAPS II was 42 .…”

Section: Study Populationmentioning

confidence: 99%

“…Although the rates and mechanisms of bleeding and thrombosis in COVID-19 patients have been extensively studied, relatively little is known about bleeding and thrombosis risks of COVID-19 patients on ECMO. The existing data are limited to small singlecenter series and one multicenter study [27][28][29][30][31][32][33][34][35][36][37].…”

Section: Introductionmentioning

confidence: 99%

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Bleeding and thrombotic events in patients with severe COVID-19 supported with extracorporeal membrane oxygenation: a nationwide cohort study

et al. 2022

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Purpose: To describe bleeding and thrombotic events and their risk factors in patients receiving extracorporeal membrane oxygenation (ECMO) for severe coronavirus disease 2019 (COVID-19) and to evaluate their impact on inhospital mortality. Methods:The ECMOSARS registry included COVID-19 patients supported by ECMO in France. We analyzed all patients included up to March 31, 2022 without missing data regarding bleeding and thrombotic events. The association of bleeding and thrombotic events with in-hospital mortality and pre-ECMO variables was assessed using multivariable logistic regression models.Results: Among 620 patients supported by ECMO, 29% had only bleeding events, 16% only thrombotic events and 20% both bleeding and thrombosis. Cannulation site (18% of patients), ear nose and throat (12%), pulmonary bleeding (9%) and intracranial hemorrhage (8%) were the most frequent bleeding types. Device-related thrombosis and pulmonary embolism/thrombosis accounted for most of thrombotic events. In-hospital mortality was 55.7%. Bleeding events were associated with in-hospital mortality (adjusted odds ratio (adjOR) = 2. 91[1.94-4.4]) but not thrombotic events (adjOR = 1. 02[0.68-1.53]). Intracranial hemorrhage was strongly associated with in-hospital mortality ). Ventilation duration before ECMO ≥ 7 days and length of ECMO support were associated with bleeding. Thrombosis-associated factors were fibrinogen ≥ 6 g/L and length of ECMO support.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Bleeding and thrombotic events in patients with severe COVID-19 supported with extracorporeal membrane oxygenation: a nationwide cohort study

et al. 2022

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“…The overall in-hospital mortality varied widely across included studies; the lowest was 15.1% and the highest was 80.8%, as well as the pooled estimate was 40.3% (95% CI: 33.1%–47.5%, p < 0.001, 12 studies, 2 , 20 - 30 6039 patients) ( Figure 4 ). Eight 20 , 22 , 23 , 25 – 28 , 30 studies reported the use of anticoagulants during ECMO, with most patients receiving unfractionated heparin (UFH). The use of argatroban was mentioned for heparin-induced thrombocytopenia in two studies.…”

Section: Resultsmentioning

confidence: 99%

Ischemic stroke and intracranial hemorrhage in extracorporeal membrane oxygenation for COVID-19: A systematic review and meta-analysis

2022

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Purpose Extracorporeal membrane oxygenation (ECMO) is employed to support critically ill COVD-19 patients. The occurrence of ischemic stroke and intracranial hemorrhage (ICH), as well as the implementation of anticoagulation strategies under the dual influence of ECMO and COVID-19 remain unclear. We conducted a systematic review and meta-analysis to describe the ischemic stroke, ICH and overall in-hospital mortality in COVID-19 patients receiving ECMO and summarize the anticoagulation regimens. Methods EMBASE, PubMed, Cochrane, and Scopus were searched for studies examining ischemic stroke, ICH, and mortality in COVID-19 patients supported with ECMO. The outcomes were incidences of ischemic stroke, ICH, overall in-hospital mortality and anticoagulation regimens. We calculated the pooled proportions and 95% confidence intervals (CIs) to summarize the results. Results We analyzed 12 peer-reviewed studies involving 6039 COVID-19 patients. The incidence of ischemic stroke had a pooled estimate of 2.2% (95% CI: 1.2%–3.2%). The pooled prevalence of ICH was 8.0% (95% CI: 6.3%–9.6%). The pooled estimate of overall in-hospital mortality was 40.3% (95% CI: 33.1%–47.5%). The occurrence of ICH was significantly higher in COVID-19 patients supported with ECMO than in other respiratory ECMO [relative risk=1.75 (95% CI: 1.00–3.07)]. Unfractionated heparin was the most commonly used anticoagulant, and anticoagulation monitoring practice varied among centers. Conclusions Ischemic stroke and ICH were common under the double “hit” of COVID-19 and ECMO. The prevalence of ICH was significantly higher in COVID-19 patients supported with ECMO than non-COVID-19 patients requiring ECMO. Individualized anticoagulation regimens may be a good choice to balance thrombosis and bleeding. More detailed research and further exploration are needed to clarify the underlying mechanism and clinical management decisions.

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Intracranial hemorrhage in patients treated for SARS-CoV-2 with extracorporeal membrane oxygenation: A systematic review and meta-analysis

Lannon

Duda

Greer

et al. 2023

Journal of Critical Care

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Impact of Thrombosis and Bleeding in Patients with Severe COVID-19 versus Other Viral Pneumonias in the Context of Extracorporeal Membrane Oxygenation

Abstract: Letter to the EditorThis document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.

Cited by 8 publications

References 11 publications

Bleeding and thrombotic events in patients with severe COVID-19 supported with extracorporeal membrane oxygenation: a nationwide cohort study

Bleeding and thrombotic events in patients with severe COVID-19 supported with extracorporeal membrane oxygenation: a nationwide cohort study

Ischemic stroke and intracranial hemorrhage in extracorporeal membrane oxygenation for COVID-19: A systematic review and meta-analysis

Intracranial hemorrhage in patients treated for SARS-CoV-2 with extracorporeal membrane oxygenation: A systematic review and meta-analysis

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