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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Frontiers Media S.A.
2025-08-01
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2025.1649217/full |
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| author | Johannes Herrmann Janno Schade Patrick Meybohm Noah Paschke Martha E. Hübsch Quirin Notz Julie Groene Daniel Röder Peter Kranke Michaela L. Merten Micha Landoll Micha Landoll Micha Landoll Peter Spieth Stefan Kluge Dominik Jarczak Kevin Roedl Michael Sonntagbauer Christian Putensen Jens-Christian Schewe 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 Tobias Wengenmayer Dawid L. Staudacher Dawid L. Staudacher Viviane Zotzmann 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 Rebecca Roth Rebecca Roth Anna Grau Peter Heuschmann Peter Heuschmann Peter Heuschmann Christian Karagiannidis Christopher Lotz |
| author_facet | Johannes Herrmann Janno Schade Patrick Meybohm Noah Paschke Martha E. Hübsch Quirin Notz Julie Groene Daniel Röder Peter Kranke Michaela L. Merten Micha Landoll Micha Landoll Micha Landoll Peter Spieth Stefan Kluge Dominik Jarczak Kevin Roedl Michael Sonntagbauer Christian Putensen Jens-Christian Schewe 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 Tobias Wengenmayer Dawid L. Staudacher Dawid L. Staudacher Viviane Zotzmann 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 Rebecca Roth Rebecca Roth Anna Grau Peter Heuschmann Peter Heuschmann Peter Heuschmann Christian Karagiannidis Christopher Lotz |
| author_sort | Johannes Herrmann |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-2beda819e907416babd071a28e43aa02 |
| institution | Kabale University |
| issn | 2296-858X |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj-art-2beda819e907416babd071a28e43aa022025-08-20T05:32:26ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2025-08-011210.3389/fmed.2025.16492171649217Impact of bleeding and thrombosis on outcome of 945 COVID-19 VV-ECMO cases from a German registryJohannes Herrmann0Janno Schade1Patrick Meybohm2Noah Paschke3Martha E. Hübsch4Quirin Notz5Julie Groene6Daniel Röder7Peter Kranke8Michaela L. Merten9Micha Landoll10Micha Landoll11Micha Landoll12Peter Spieth13Stefan Kluge14Dominik Jarczak15Kevin Roedl16Michael Sonntagbauer17Christian Putensen18Jens-Christian Schewe19Jens-Christian Schewe20Stefan F. Ehrentraut21Stefan Kreyer22Andreas Wehrfritz23Ixchel Castellanos24Karl Bihlmaier25Karsten Schmidt26Thorsten Brenner27Frank Herbstreit28Florian Espeter29Jan Wiefhoff30Richard K. Ellerkmann31Daniel Oswald32Björn Ellger33Gösta Lotz34Florian J. Raimann35Tobias Wengenmayer36Tobias Wengenmayer37Dawid L. Staudacher38Dawid L. Staudacher39Viviane Zotzmann40Viviane Zotzmann41Onnen Moerer42Christian Kühn43Matthias Kochanek44Ralf Muellenbach45Patricia Glaser46Falk Fichtner47Marc Bodenstein48Michael Findeisen49Vanessa Rembold50Markus Heim51Gerhard Schneider52Tobias Lahmer53Jan-Sören Padberg54Carsten Hullermann55Philipp M. Lepper56Andre P. Becker57Guy Danziger58Carlos Metz59Peter Rosenberger60Valbona Mirakaj61Alice-Marie Bernard62Stephan Braune63Rebecca Roth64Rebecca Roth65Rebecca Roth66Anna Grau67Peter Heuschmann68Peter Heuschmann69Peter Heuschmann70Christian Karagiannidis71Christopher Lotz72Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, GermanyDepartment of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, GermanyDepartment of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, GermanyDepartment of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, GermanyDepartment of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, GermanyDepartment of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, GermanyDepartment of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, GermanyDepartment of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, GermanyDepartment of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, GermanyDepartment of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Center, Kliniken der Stadt Köln, Witten/Herdecke University Hospital, Cologne, GermanyDepartment of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Center, Kliniken der Stadt Köln, Witten/Herdecke University Hospital, Cologne, GermanyDepartment of Cardiovascular Engineering, Institute of Applied Medical Engineering, Medical Faculty, RWTH Aachen University, Aachen, GermanyInstitute for Computational Biomedicine, Medical Faculty, RWTH Aachen University, Aachen, GermanyDepartment of Anesthesiology and Intensive Care Medicine, University Hospital, Dresden at the TU Dresden, Dresden, GermanyDepartment of Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, GermanyDepartment of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, GermanyDepartment of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Medical Centre Rostock, Rostock, GermanyDepartment of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, GermanyDepartment of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, GermanyDepartment of Anaesthesiology, University Hospital Erlangen, Friedrich-Alexander University, Erlangen- Nuernberg (FAU), Erlangen, GermanyDepartment of Anaesthesiology, University Hospital Erlangen, Friedrich-Alexander University, Erlangen- Nuernberg (FAU), Erlangen, Germany0Department of Internal Medicine 4 – Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University, Erlangen-Nuernberg (FAU), Erlangen, Germany1Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany1Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany1Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany1Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany1Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany2Department of Anesthesiologie and Intensive Care Medicine, Klinikum Dortmund, Klinikum University Witten/Herdecke, Dortmund, Germany3Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Clinic Centre Westfalen, Dortmund, Germany3Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Clinic Centre Westfalen, Dortmund, Germany4Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt, Germany4Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt, Germany5Department of Cardiology and Angiology I (Heart Center Freiburg - Bad Krozingen), Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany6Interdisciplinary Medical Intensive Care (IMIT), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany5Department of Cardiology and Angiology I (Heart Center Freiburg - Bad Krozingen), Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany6Interdisciplinary Medical Intensive Care (IMIT), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany6Interdisciplinary Medical Intensive Care (IMIT), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany7Ortenau Klinikum, Department of Cardiology, Pneumology, Acut Geriatrics, Angiology, Intensiv Care Medicine and Thoracic Surgery (DKPAAIT), Offenburg, Germany8Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany9Department of Cardiothoracic, Transplanatation and Vascular Surgery, Hannover Medical School, Hannover, Germany0Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany1Department of Anesthesiology and Critical Care Medicine, ARDS/ECMO-Center, Campus Kassel of the University of Southampton, Kassel, Germany2Departement of Anaesthesia, perioperative Medicine and Interdisciplinary Intensive Care Medicine, ECLS/ECMO-Center, Asklepios Klinik Langen, Langen, Germany3Department of Anesthesiology and Intensive Care Medicine, University of Leipzig Medical Center, Leipzig, Germany4Department of Anesthesiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany5Klinik für Pneumologie, Internistische Intensiv- und Beatmungsmedizin, München Klinik Harlaching, Munich, Germany5Klinik für Pneumologie, Internistische Intensiv- und Beatmungsmedizin, München Klinik Harlaching, Munich, Germany6Department of Anaesthesiology and Intensive Care Medicine, Klinikum Rechts der Isar, TUM School of Medicine and Health, Munich, Germany6Department of Anaesthesiology and Intensive Care Medicine, Klinikum Rechts der Isar, TUM School of Medicine and Health, Munich, Germany7Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, University of Munich, Munich, Germany8Department of Cardiology I – Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Muenster, Germany8Department of Cardiology I – Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Muenster, Germany9Department of Internal Medicine V- Pneumology, Allergology and Critical Care Medicine, Saarland University, Homburg, Germany9Department of Internal Medicine V- Pneumology, Allergology and Critical Care Medicine, Saarland University, Homburg, Germany9Department of Internal Medicine V- Pneumology, Allergology and Critical Care Medicine, Saarland University, Homburg, Germany9Department of Internal Medicine V- Pneumology, Allergology and Critical Care Medicine, Saarland University, Homburg, Germany0Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany0Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany0Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany1Department of Medical Intensive Care and Emergency Medicine, St. Franziskus-Hospital Muenster, Münster, Germany2Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany3Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany4Department of Health Services Research, German Cancer Society, Berlin, Germany2Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany2Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany3Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany5Institute for Medical Data Science, University Hospital Würzburg, Würzburg, GermanyDepartment of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Center, Kliniken der Stadt Köln, Witten/Herdecke University Hospital, Cologne, GermanyDepartment of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, GermanyBleeding 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.https://www.frontiersin.org/articles/10.3389/fmed.2025.1649217/fullCOVID-19acute respiraratory distress syndromeextracorporeal membrance oxygenationbleedingthromboembolism |
| spellingShingle | Johannes Herrmann Janno Schade Patrick Meybohm Noah Paschke Martha E. Hübsch Quirin Notz Julie Groene Daniel Röder Peter Kranke Michaela L. Merten Micha Landoll Micha Landoll Micha Landoll Peter Spieth Stefan Kluge Dominik Jarczak Kevin Roedl Michael Sonntagbauer Christian Putensen Jens-Christian Schewe 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 Tobias Wengenmayer Dawid L. Staudacher Dawid L. Staudacher Viviane Zotzmann 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 Rebecca Roth Rebecca Roth Anna Grau Peter Heuschmann Peter Heuschmann Peter Heuschmann Christian Karagiannidis Christopher Lotz Impact of bleeding and thrombosis on outcome of 945 COVID-19 VV-ECMO cases from a German registry Frontiers in Medicine COVID-19 acute respiraratory distress syndrome extracorporeal membrance oxygenation bleeding thromboembolism |
| title | Impact of bleeding and thrombosis on outcome of 945 COVID-19 VV-ECMO cases from a German registry |
| title_full | Impact of bleeding and thrombosis on outcome of 945 COVID-19 VV-ECMO cases from a German registry |
| title_fullStr | Impact of bleeding and thrombosis on outcome of 945 COVID-19 VV-ECMO cases from a German registry |
| title_full_unstemmed | Impact of bleeding and thrombosis on outcome of 945 COVID-19 VV-ECMO cases from a German registry |
| title_short | Impact of bleeding and thrombosis on outcome of 945 COVID-19 VV-ECMO cases from a German registry |
| title_sort | impact of bleeding and thrombosis on outcome of 945 covid 19 vv ecmo cases from a german registry |
| topic | COVID-19 acute respiraratory distress syndrome extracorporeal membrance oxygenation bleeding thromboembolism |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2025.1649217/full |
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