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

2022; Springer Science+Business Media; Volume: 48; Issue: 8 Linguagem: Inglês

10.1007/s00134-022-06794-y

1432-1238

Alexandre Mansour, Erwan Flécher, Matthieu Schmidt, Bertrand Rozec, Isabelle Gouin‐Thibault, Maxime Esvan, Claire Fougerou, Bruno Lévy, Alizée Porto, James T. Ross, Marylou Para, Sabrina Manganiello, Guillaume Lebreton, André Vincentelli, Nicolas Nesseler, Marc Pierrot, Sidney Chocron, Guillaume Flicoteaux, Philippe Mauriat, Alexandre Ouattara, Hadrien Rozé, Olivier Huet, Marc‐Olivier Fischer, Claire Alessandri, Raphel Bellaïche, Ophélie Constant, Quentin de Roux, André Ly, Arnaud Meffert, Jean‐Claude Merle, Nicolas Mongardon, L Picard, Elena Skripkina, Thierry Folliguet, Antonio Fiore, Nicolas D’ostrevy, Marie-Catherine Morgan, Pierre-Grégoire Guinot, Maxime Nguyen, Lucie Gaide‐Chevronnay, Nicolas Terzi, Gwenhaël Colin, Olivier Fabre, Arash Astaneh, Justin Issard, Élie Fadel, Dominique Fabre, Antoine Girault, Julien Guihaire, Iolande Ion, Jean-Baptiste Ménager, Délphine Mitilian, Olaf Mercier, François Stéphan, Jacques Thès, Jérôme Jouan, Thibault Duburcq, Valentin Loobuyck, Mouhammed Moussa, A Mugnier, Natacha Rousse, Olivier Desebbe, Jean-Luc Fellahi, Roland Hénaine, Matteo Pozzi, Jean‐Christophe Richard, Zakaria Riad, Christophe Guervilly, Sami Hraiech, Laurent Papazian, Matthias Castanier, C. Chanavaz, Cyril Cadoz, Sébastien Gette, Guillaume Louis, Erick Portocarrero, Philippe Gaudard, Kais Brini, Nicolas Bischoff, Antoine Kimmoun, Mathieu Mattèi, Pierre Perez, Alexandre Bourdiol, Yannick Hourmant, Pierre-Joachim Mahé, Pierre Jaquet, Brice Lortat‐Jacob, Pierre Mordant, Patrick Nataf, Juliette Patrier, Sophie Provenchère, Morgan Roué, Romain Sonneville, Alexy Tran‐Dinh, Paul-Henri Wicky, Charles Al Zreibi, Bernard Cholley, Yannis Guyonvarch, Sophie Hamada, Anatole Harrois, Jordi Matiello, Thomas Kerforne, C. Lacroix, Nicolas Bréchot, Alain Combes, Juliette Chommeloux, Jean Michel Constantin, Cosimo D’Alessandro, Pierre Demondion, Alexandre Demoule, Martin Dres, Guillaume Fadel, Muriel Fartoukh, Guillaume Hékimian, Charles Juvin, Pascal Leprince, David Levy, Charles Edouard Luyt, Marc Pineton de Chambrun, Thibaut Schoell, Pierre Fillâtre, Nicolas Massart, Roxane Nicolas, Maud Jonas, Charles Vidal, Nicolas Allou, Salvatore Muccio, Dario Di Perna, Vito Giovanni Ruggieri, Bruno Mourvillier, Amédéo Anselmi, Karl Bounader, Yoann Launey, Thomas Lebouvier, Alessandro Parasido, Florian Reizine, Philippe Séguin, Emmanuel Besnier, Dorothée Carpentier, Thomas Clavier, Pierre‐Emmanuel Falcoz, Anne Olland, Marion Villard, Fanny Vardon‐Bounes, François Labaste, Vincent Minville, Antoine Guillon, Yannick Fédun,

Long-Term Effects of COVID-19

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.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.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.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.