Thorac Cardiovasc Surg
DOI: 10.1055/s-0041-1725180
Original Cardiovascular

Thromboembolic and Bleeding Events in COVID-19 Patients receiving Extracorporeal Membrane Oxygenation

Koray Durak+
1  Department of Thoracic and Cardiovascular Surgery, Uniklinik RWTH Aachen, Aachen, Germany
2  Radboudumc, Nijmegen, The Netherlands
,
Alexander Kersten+
3  Department of Cardiology, Angiology and Intensive Care, Uniklinik RWTH Aachen, Aachen, Germany
,
Oliver Grottke
4  Department of Anesthesiology, Uniklinik RWTH Aachen, Aachen, Germany
,
1  Department of Thoracic and Cardiovascular Surgery, Uniklinik RWTH Aachen, Aachen, Germany
,
Michael Dreher
5  Department of Pneumology and Intensive Care Medicine, Uniklinik RWTH Aachen, Aachen, Germany
,
Rüdiger Autschbach
1  Department of Thoracic and Cardiovascular Surgery, Uniklinik RWTH Aachen, Aachen, Germany
,
Gernot Marx
6  Department of Intensive Care and Intermediate Care Medicine, Uniklinik RWTH Aachen, Aachen, Germany
,
Nikolaus Marx
3  Department of Cardiology, Angiology and Intensive Care, Uniklinik RWTH Aachen, Aachen, Germany
,
Jan Spillner
1  Department of Thoracic and Cardiovascular Surgery, Uniklinik RWTH Aachen, Aachen, Germany
,
Sebastian Kalverkamp
1  Department of Thoracic and Cardiovascular Surgery, Uniklinik RWTH Aachen, Aachen, Germany
› Author Affiliations

Abstract

Background Extracorporeal membrane oxygenation (ECMO) is a potential treatment option in critically ill COVID-19 patients suffering from acute respiratory distress syndrome (ARDS) if mechanical ventilation (MV) is insufficient; however, thromboembolic and bleeding events (TEBE) during ECMO treatment still need to be investigated.

Methods We conducted a retrospective, single-center study including COVID-19 patients treated with ECMO. Additionally, we performed a univariate analysis of 85 pre-ECMO variables to identify factors influencing incidences of thromboembolic events (TEE) and bleeding events (BE), respectively.

Results Seventeen patients were included; the median age was 57 years (interquartile range [IQR]: 51.5–62), 11 patients were males (65%), median ECMO duration was 16 days (IQR: 10.5–22), and the overall survival was 53%. Twelve patients (71%) developed TEBE. We observed 7 patients (41%) who developed TEE and 10 patients (59%) with BE. Upper respiratory tract (URT) bleeding was the most frequent BE with eight cases (47%). Regarding TEE, pulmonary artery embolism (PAE) had the highest incidence with five cases (29%). The comparison of diverse pre-ECMO variables between patients with and without TEBE detected one statistically significant value. The platelet count was significantly lower in the BE group (n = 10) than in the non-BE group (n = 7) with 209 (IQR: 145–238) versus 452 G/L (IQR: 240–560), with p = 0.007.

Conclusion This study describes the incidences of TEE and BE in critically ill COVID-19 patients treated with ECMO. The most common adverse event during ECMO support was bleeding, which occurred at a comparable rate to non-COVID-19 patients treated with ECMO.

+ Both authors contributed equally to this study.


Authors’ Contribution

Koray Durak has collected the data (60%), performed data Analysis (55%) and wrote the first version of the manuscript (100%). Alex Kersten contributed to the Study design (50%), performed ECMO implantation (35%), collected the data (40%), performed data analysis (45%), supervised the writing process of the first version of the manuscript, critically revised the manuscript. The above mentioned contribution justify a contributed equally authorship of both authors Koray Durak and Alex Kersten.




Publication History

Received: 28 November 2020

Accepted: 18 January 2021

Publication Date:
16 April 2021 (online)

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