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CC BY-NC-ND 4.0 · Thromb Haemost 2025; 125(04): 308-316
DOI: 10.1055/a-2411-1000
Coagulation and Fibrinolysis

Characteristics of Bleeding Complications in Patients with Severe COVID-19 Requiring Veno-venous Extracorporeal Membrane Oxygenation in Japan

Authors

  • Hayato Taniguchi 

    1   Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
    2   Non-profit Organization Japan ECMO Network, Tokyo, Japan

  • Takeru Abe

    1   Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan

  • Ichiro Takeuchi

    1   Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
    2   Non-profit Organization Japan ECMO Network, Tokyo, Japan

  • Shinichiro Ohshimo

    2   Non-profit Organization Japan ECMO Network, Tokyo, Japan
    3   Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan

  • Nobuaki Shime

    2   Non-profit Organization Japan ECMO Network, Tokyo, Japan
    3   Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan

  • Shigeki Kushimoto

    2   Non-profit Organization Japan ECMO Network, Tokyo, Japan
    4   Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan

  • Satoru Hashimoto

    2   Non-profit Organization Japan ECMO Network, Tokyo, Japan
    5   Non-Profit Organization ICU Collaboration Network (ICON), Tokyo, Japan

  • Shinhiro Takeda

    2   Non-profit Organization Japan ECMO Network, Tokyo, Japan
    6   Kawaguchi Cardiovascular and Respiratory Hospital, Kawaguchi, Japan
    • on behalf of the Japan ECMO Network

Funding This research was funded by the Japan Agency for Medical Research and Development (grant number: JP22fk0108654).
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Abstract

Background

Complications during veno-venous extracorporeal membrane oxygenation (VV-ECMO) are associated with in-hospital mortality. Asian patients on extracorporeal membrane oxygenation (ECMO) have higher risks of bleeding and in-hospital mortality than Caucasian patients. This study aimed to characterize and identify bleeding complications and their associated factors related to in-hospital mortality in patients with severe coronavirus disease 2019 (COVID-19) requiring VV-ECMO in Japan.

Methods

In this retrospective observational analysis, the prospective nationwide multicenter registry was used to track real-time information from intensive care units throughout Japan during the COVID-19 pandemic. VV-ECMO patients' registry data between February 1, 2020 and October 31, 2022 were used.

Results

This study included 441 patients; 178 (40%) had bleeding complications in the following sites: 20% at the cannulation site, 16% in the gastrointestinal tract, 16% in the ear–nose–throat, 13% at the tracheostomy site, 9% intrathoracic, 6% intracranial, and 5% in the iliopsoas. Anticoagulation was discontinued in >50% of patients with intracranial, iliopsoas, and gastrointestinal tract bleeding. ECMO was discontinued in one-third of patients with intracranial, intramuscular, and iliopsoas hemorrhages. Multivariable logistic regression analysis revealed that only gastrointestinal tract bleeding was associated with in-hospital mortality (odds ratio: 2.49; 95% confidence interval: 1.11–5.60; p = 0.03).

Conclusion

Incidence of bleeding complications was 40% in the Japanese population. Gastrointestinal tract bleeding emerged as a significant predictor of adverse outcomes, necessitating further research into preventive strategies and optimized care protocols. These findings can guide the management of VV-ECMO patients with COVID-19.

Keywords

bleeding - coronavirus disease 2019 - gastrointestinal tract - respiratory distress syndrome - mortality

Ethical Approval Statement

This study was approved by the Institutional Review Board of Yokohama City University (approval number: B200700034), and the need for informed consent was waived owing to its retrospective nature. Instead, an opt-out statement was posted on the Web site. The study was conducted according to the principles of the Declaration of Helsinki.


Supplementary Material



Publication History

Received: 18 June 2024

Accepted: 02 September 2024

Accepted Manuscript online:
06 September 2024

Article published online:
27 September 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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