Alexandre Mansour1,2,3, Erwan Flecher4, Matthieu Schmidt5,6, Bertrand Rozec7,8, Isabelle Gouin-Thibault9,10, Maxime Esvan11,12, Claire Fougerou11,12, Bruno Levy13,14,15, Alizée Porto16, James T Ross17, Marylou Para18,19, Sabrina Manganiello20, Guillaume Lebreton6,21, André Vincentelli20,22, Nicolas Nesseler23,9,24. 1. Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Rennes, France. alexandre.mansour@chu-rennes.fr. 2. Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), 35000, Rennes, France. alexandre.mansour@chu-rennes.fr. 3. Hôpital Pontchaillou, Pôle Anesthésie, SAMU, Urgences, Réanimations, Médecine Interne et Gériatrie (ASUR-MIG), 2 rue Henri Le Guilloux, 35033, Rennes Cedex 9, France. alexandre.mansour@chu-rennes.fr. 4. Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, University of Rennes 1, Signal and Image Treatment Laboratory (LTSI), Inserm U1099, Rennes, France. 5. Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013, Paris, France. 6. Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, 75013, Paris, France. 7. Cardiothoracic and Cardiovascular Intensive Care Unit, Laennec University Hospital, Saint-Herblain, France. 8. Institut du Thorax, Institut National de la Santé et de la Recherche Médicale UMR1087 IRT, Paris, France. 9. Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), 35000, Rennes, France. 10. Department of Hematology, Pontchaillou, University Hospital of Rennes, Rennes, France. 11. Department of Clinical Pharmacology, University Hospital, Rennes 1 University, 35033, Rennes, France. 12. Inserm CIC 1414, Clinical Investigation Centre, University Hospital, Rennes 1 University, 35033, Rennes, France. 13. Médecine Intensive Et Réanimation, CHRU Nancy, Pôle Cardio-Médico-Chirurgical, 54511, Vandœuvre-lès-Nancy, France. 14. INSERM U1116, Faculté de Médecine, 54511, Vandoeuvre-lès-Nancy, France. 15. Université de Lorraine, 54000, Nancy, France. 16. Department of Cardiac Surgery, Timone Hospital, APHM, 13005, Marseille, France. 17. Department of Surgery, University of California Davis, Sacramento, USA. 18. Department of Cardiovascular Surgery and Transplantation, Bichat Hospital, AP-HP, Paris, France. 19. University of Paris, UMR 1148, Laboratory of Vascular Translational Science, Paris, France. 20. Univ. Lille, CHU Lille, Cardiac Surgery, 59000, Lille, France. 21. Service de Chirurgie Thoracique et Cardiovasculaire, Institut de Cardiologie, APHP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France. 22. Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, 59000, Lille, France. 23. Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Rennes, France. 24. Univ Rennes, CHU de Rennes, Inra, Inserm, Institut NUMECAN-UMR_A 1341, UMR_S 1241, 35000, Rennes, France.
Abstract
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 in-hospital 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 (adjOR = 13.5[4.4-41.5]). 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. CONCLUSIONS: In a nationwide cohort of COVID-19 patients supported by ECMO, bleeding incidence was high and associated with mortality. Intracranial hemorrhage incidence was higher than reported for non-COVID patients and carried the highest risk of death. Thrombotic events were less frequent and not associated with mortality. Length of ECMO support was associated with a higher risk of both bleeding and thrombosis, supporting the development of strategies to minimize ECMO duration.
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 in-hospital 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 (adjOR = 13.5[4.4-41.5]). 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. CONCLUSIONS: In a nationwide cohort of COVID-19 patients supported by ECMO, bleeding incidence was high and associated with mortality. Intracranial hemorrhage incidence was higher than reported for non-COVID patients and carried the highest risk of death. Thrombotic events were less frequent and not associated with mortality. Length of ECMO support was associated with a higher risk of both bleeding and thrombosis, supporting the development of strategies to minimize ECMO duration.
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