OC 61.2 - Thrombosis and major bleeding in patients with severe COVID-19 supported by extracorporeal membrane oxygenation (ECMO)- multicentre observational study in UK

Tuesday, July 12, 2022

3:00 PM – 3:15 PM

Location: ExCel Center, S11A

Presentation Format: In-Person

Presenting Author(s)

DA

Deepa J. Arachchillage, MD

consultant haematologist
Imperial College London
London, England, United Kingdom

Co-Author(s)

IR

Indika J. Rajakaruna

Data Science AI Professional
University of East London
London, England, United Kingdom
IS

Ian Scott

Consultant Intensive Care
NHS Grampian
Aberdeen, Scotland, United Kingdom
Michael A. Laffan, MD

Professor
Centre for Haematology, Imperial College London, London, UK
London, England, United Kingdom
SL

Stephane Ledot

Consultant Intensive Care
Royal Brompton Hospital
London, England, United Kingdom
RJ

Rachel Jooste

Consultant Intensive Care
Royal Papworth Hospital NHS Foundation Trust
Cambridge, England, United Kingdom
AV

Alain Vuylsteke

Consultant Intensive Care
Royal Papworth Hospital NHS Foundation Trust
Cambridge, England, United Kingdom
YH

Yusuff Hakeem

Consultant Intensive Care
The University Hospitals of Leicester NHS Trust
Leicester, England, United Kingdom

Background: Support with extracorporeal membrane oxygenation (ECMO) can be life saving for patients with coronavirus [Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2)]-induced severe respiratory failure. However, bleeding and thrombosis are major complications in patients supported with ECMO and thrombosis is itself a prominent feature of severe COVID-19.

Aims: To assess the rate of thrombosis and major bleeding (MB) and their impact on mortality in patients supported with veno-venous (VV)-ECMO.

Methods: This was a multicentre observational study of 320 consecutive patients (≥18 years) with severe COVID-19 supported by VV-ECMO in four nationally commissioned ECMO centres in UK from 1st March 2020 to 31st December 2021.

Results: Median age (range) was 48 years (19–75) and 71.2% were male. Overall, the 180-day mortality was 36.6%% (117/320). The rate of MB was 27.5% (88/320), of which intracranial bleeding (ICH) was the most common [35.3% (31/88) [ followed by pulmonary haemorrhage [26.1% (23/88). Gastrointestinal bleeding accounted for 15.9% (14/88) of MB and the remainder (22.7%) had bleeding at other sites. There were 136 thrombotic events (42.5%) consisting of 80.1% (109/136) venous thrombosis (VTE) and 19.9% (27/136) arterial thromboses. Of the 109 patients with VTE, 73.4% (80/109) had pulmonary embolism (PE), 17.4% (19/109) had deep vein thrombosis (DVT) and 9.2% (10/109) had combined DVT and PE. Ischaemic stroke accounted for > 50% of the arterial thrombosis (51.6%, 14/27). HIT occurred in 9.7% (31/320) and 80.6% (25/31) developed thrombosis. MB and ICH were associated with 3.51-fold (95% CI 2.56–8.41) and 6.71-fold (CI) 2.56–16.54] increased risk of mortality and PE with a 2.23-fold (95% CI1.29–3.89) risk of mortality.

Conclusion(s): MB and thrombosis including HIT are frequent complications in patients supported with VV-ECMO which significantly increase the risk of mortality. This highlights the need for prospective studies assessing the optimal haemostasis management in patients on VV-ECMO.