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Background <p>Patients with severe COVID-19 often require veno-venous extracorporeal membrane oxygenation (VV-ECMO) due to acute respiratory distress syndrome (ARDS). Major bleeding complications are common and linked to worse outcomes, though specific risk factors in COVID-19 remain unclear.</p> Methods <p>A retrospective analysis of 151 critically ill patients with COVID-19 on VV-ECMO (March 2020–December 2021) was conducted. The primary outcome was major bleeding (fatal bleeding, haemoglobin drop ≥ 20&#xa0;g/L<sup>−1</sup> (1.24 mmol/L<sup>−1</sup>), or symptomatic bleeding in critical organs). Secondary outcomes included 90-day mortality, kidney replacement therapy, and disease severity.</p> Results <p>Major bleeding occurred in 73/151 patients (48.3%). Only a longer ECMO duration [OR 1.32 (95% CI 1.14–1.53; <i>p</i> &lt; 0.001)] was identified as an independent risk factor. Kidney replacement therapy independently influenced 90-day mortality [OR 4.48 (95% CI 1.83–10.98;<i>p</i> = 0.001). However, major bleeding, intracranial haemorrhage, higher burden of co-morbidity and mean aPTT before major bleeding were not associated with an increased 90-day mortality risk.</p> Conclusion <p>Major bleeding events, including intracranial haemorrhage, are common in patients with COVID-19 being supported by VV-ECMO. However, our data does not demonstrate a direct association between major bleeding and increased 90-day mortality.</p>

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Outcome of patients with COVID-19 supported by veno-venous extracorporeal membrane oxygenation with major bleeding: a single centre experience

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月2日

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  • Simon Dubler,
  • Michael Kowarik,
  • Bettina Budeus,
  • Tomas Habanik,
  • Denise Zwanziger,
  • Annabell Skarabis,
  • Florian Espeter,
  • Thorsten Brenner,
  • Frank Herbstreit

摘要

Background

Patients with severe COVID-19 often require veno-venous extracorporeal membrane oxygenation (VV-ECMO) due to acute respiratory distress syndrome (ARDS). Major bleeding complications are common and linked to worse outcomes, though specific risk factors in COVID-19 remain unclear.

Methods

A retrospective analysis of 151 critically ill patients with COVID-19 on VV-ECMO (March 2020–December 2021) was conducted. The primary outcome was major bleeding (fatal bleeding, haemoglobin drop ≥ 20 g/L−1 (1.24 mmol/L−1), or symptomatic bleeding in critical organs). Secondary outcomes included 90-day mortality, kidney replacement therapy, and disease severity.

Results

Major bleeding occurred in 73/151 patients (48.3%). Only a longer ECMO duration [OR 1.32 (95% CI 1.14–1.53; p < 0.001)] was identified as an independent risk factor. Kidney replacement therapy independently influenced 90-day mortality [OR 4.48 (95% CI 1.83–10.98;p = 0.001). However, major bleeding, intracranial haemorrhage, higher burden of co-morbidity and mean aPTT before major bleeding were not associated with an increased 90-day mortality risk.

Conclusion

Major bleeding events, including intracranial haemorrhage, are common in patients with COVID-19 being supported by VV-ECMO. However, our data does not demonstrate a direct association between major bleeding and increased 90-day mortality.