Impact of bleeding and thrombosis on outcome of 945 COVID-19 VV-ECMO cases from a German registry

Impact of bleeding and thrombosis on outcome of 945 COVID-19 VV-ECMO cases from a German registry

Bleeding and thromboembolic events (BTE) increase the mortality of COVID-19 acute respiratory distress syndrome (ARDS) treated with extracorporeal membrane oxygenation (ECMO). The current analysis aimed to assess frequency and determinants of BTE according to their location and severity in a retrosp...

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Main Authors: Johannes Herrmann, Janno Schade, Patrick Meybohm, Noah Paschke, Martha E. Hübsch, Quirin Notz, Julie Groene, Daniel Röder, Peter Kranke, Michaela L. Merten, Micha Landoll, Peter Spieth, Stefan Kluge, Dominik Jarczak, Kevin Roedl, Michael Sonntagbauer, Christian Putensen, Jens-Christian Schewe, Stefan F. Ehrentraut, Stefan Kreyer, Andreas Wehrfritz, Ixchel Castellanos, Karl Bihlmaier, Karsten Schmidt, Thorsten Brenner, Frank Herbstreit, Florian Espeter, Jan Wiefhoff, Richard K. Ellerkmann, Daniel Oswald, Björn Ellger, Gösta Lotz, Florian J. Raimann, Tobias Wengenmayer, Dawid L. Staudacher, Viviane Zotzmann, Onnen Moerer, Christian Kühn, Matthias Kochanek, Ralf Muellenbach, Patricia Glaser, Falk Fichtner, Marc Bodenstein, Michael Findeisen, Vanessa Rembold, Markus Heim, Gerhard Schneider, Tobias Lahmer, Jan-Sören Padberg, Carsten Hullermann, Philipp M. Lepper, Andre P. Becker, Guy Danziger, Carlos Metz, Peter Rosenberger, Valbona Mirakaj, Alice-Marie Bernard, Stephan Braune, Rebecca Roth, Anna Grau, Peter Heuschmann, Christian Karagiannidis, Christopher Lotz
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-08-01
Series:Frontiers in Medicine
Subjects:
COVID-19
acute respiraratory distress syndrome
extracorporeal membrance oxygenation
bleeding
thromboembolism
Online Access:https://www.frontiersin.org/articles/10.3389/fmed.2025.1649217/full
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Summary:Bleeding and thromboembolic events (BTE) increase the mortality of COVID-19 acute respiratory distress syndrome (ARDS) treated with extracorporeal membrane oxygenation (ECMO). The current analysis aimed to assess frequency and determinants of BTE according to their location and severity in a retrospective analysis of the German ECMO COVID-19 registry. Logistic regression was applied to identify factors influencing ICU survival as well as variables associated with risks of BTE. In total, 708 of 945 patients (75%) suffered from BTE. Overall, 1,348 events were registered, including 406 (30%) major bleeding and 258 (19%) major thromboembolic events. Most common major bleeding locations were intracranial (n = 133, 10%) and pulmonary bleeding (n = 116, 9%). In-ICU survival was 35, 46% without BTE and 22% with major bleeding (p < 0.05). In summary, major bleeding was a core outcome-determinant of COVID-19 ECMO mortality with intracranial major bleeding as the most devastating complication (OR: 5.3; CI: 2.9–9.9; p < 0.001). Neither major thromboembolism nor minor BTE impacted ICU-mortality. Potentially modifiable factors associated with major bleeding included prolonged duration of ECMO >14 days (OR: 2.9; CI 1.8–4.7; p < 0.001) and platelet counts <100.000/μL ≥ 72 h (OR: 2.0; CI 1.1–3.6; p = 0.018). Hence, prevention, early recognition and treatment of major bleedings are key to increase the survival of COVID-19 ECMO. In this regard, our data indicate that the implementation of early weaning strategies to minimize duration of ECMO therapy and prevention of prolonged thrombocytopenia with platelet counts <100.000/μl ≥ 72 h could decrease the risk of devastating bleeds and could ameliorate survival.Clinical trial registrationRegistered in the German Clinical Trials Register (study ID: DRKS00022964), retrospectively registered, September 7th 2020, https://drks.de/DRKS00022964.
ISSN:2296-858X

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