VPB0125 - Thromboembolism in COVID-19 patients on ECMO

Background: Venous thromboembolism (VTE) is a common complication of COVID-19 (coronavirus disease 2019), which often leads to sudden deterioration and death. Patients on extracorporeal membrane oxygenation (ECMO) are at risk of developing thromboembolism. Thrombus formation within the extracorporeal circuit is the main reason for systemic thromboembolism.

Aims: Thromboembolic prophylaxis is critical in managing COVID-19 patients on ECMO. Anticoagulation is recommended to all hospitalized COVID-19 patients. The prevalence of VTE in COVID-19 patients on ECMO is unclear. We aim to investigate the VTE incidence and contribute to anticoagulation strategy and management in this specific population.

Methods: We retrospectively reviewed the data of 23 patients who were diagnosed with COVID-19 and managed with ECMO. All patients received thromboembolic prophylaxis since admission. We report our findings of the incidences of thromboembolism.

Results: Twenty-three adult patients who were diagnosed with COVID-19 received ECMO support. The mean age of patients was 44.8-year-old. None of the patients were active smokers or had chronic lung disease.

All patients received heparin for thromboembolic prophylaxis on admission. The overall VTE rate was 34.7%. Six patients developed deep vein thrombosis (DVT) (26%) with lower extremities induration. Two patients were found to have pulmonary embolism (PE) (8.7%). Four patients had clotted circuit that requiring exchange. No stroke or myocardial infarction (MI) was diagnosed in these patients. Heparin-induced thrombocytopenia (HIT) was excluded in all cases.

Conclusion(s): According to Jenner’s systemic review, 34% of 2928 ICU-managed COVID-19 patients developed VTE, with 12.6% of PE and 16.1% of DVT. 529 patients (18.0%) received ECMO. When compared to our study, there were no statistically significant differences in the incidences of VTE, DVT, or PE between these two studies, although all our patients were on ECMO. Further investigation into the prevalence and management of thromboembolism in COVID-19 patients on ECMO will lead to significantly improved outcomes for this specific patient population.