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

Hayato Taniguchi; Takeru Abe; Ichiro Takeuchi; Shinichiro Ohshimo; Nobuaki Shime; Shigeki Kushimoto; Satoru Hashimoto; Shinhiro Takeda; on behalf of the Japan ECMO Network

doi:10.1055/a-2411-1000

Thrombosis and Haemostasis, Table of Contents

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

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

²Non-profit Organization Japan ECMO Network, Tokyo, Japan
Takeru Abe

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

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

²Non-profit Organization Japan ECMO Network, Tokyo, Japan
Shinichiro Ohshimo

²Non-profit Organization Japan ECMO Network, Tokyo, Japan

³Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
Nobuaki Shime

²Non-profit Organization Japan ECMO Network, Tokyo, Japan

³Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
Shigeki Kushimoto

²Non-profit Organization Japan ECMO Network, Tokyo, Japan

⁴Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
Satoru Hashimoto

²Non-profit Organization Japan ECMO Network, Tokyo, Japan

⁵Non-Profit Organization ICU Collaboration Network (ICON), Tokyo, Japan
Shinhiro Takeda

²Non-profit Organization Japan ECMO Network, Tokyo, Japan

⁶Kawaguchi Cardiovascular and Respiratory Hospital, Kawaguchi, Japan

on behalf of the Japan ECMO Network

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

Full Text

References

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