Thombosis, major bleeding, and survival in COVID-19 supported by veno-venous extracorporeal membrane oxygenation in the first vs second wave: a multicenter observational study in the United Kingdom.

Autor:	Arachchillage DJ; Centre for Haematology, Department of Immunology and Inflammation, Imperial College London, London, UK; Department of Haematology, Imperial College Healthcare NHS Trust, London, UK. Electronic address: d.arachchillage@imperial.ac.uk., Weatherill A; Department of Haematology, Imperial College Healthcare NHS Trust, London, UK., Rajakaruna I; Department of Computer Science, University of East London, London, UK., Gaspar M; Department of Haematology, Royal Brompton Hospital, London, UK., Odho Z; Department of Biochemistry, Royal Brompton Hospital, London, UK., Isgro G; Department of Anaesthesia and Critical Care, University Hospitals of Leicester NHS Trust, Leicester, UK., Cagova L; Department of Anaesthesia and Critical Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK., Fleming L; Department of Critical Care, NHS Grampian, Aberdeen, UK., Ledot S; Department of Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK., Laffan M; Centre for Haematology, Department of Immunology and Inflammation, Imperial College London, London, UK; Department of Haematology, Imperial College Healthcare NHS Trust, London, UK., Szydlo R; Centre for Haematology, Department of Immunology and Inflammation, Imperial College London, London, UK., Jooste R; Department of Anaesthesia and Critical Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK., Scott I; Department of Critical Care, NHS Grampian, Aberdeen, UK., Vuylsteke A; Department of Anaesthesia and Critical Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK., Yusuff H; Department of Anaesthesia and Critical Care, University Hospitals of Leicester NHS Trust, Leicester, UK.
Jazyk:	angličtina
Zdroj:	Journal of thrombosis and haemostasis : JTH [J Thromb Haemost] 2023 Oct; Vol. 21 (10), pp. 2735-2746. Date of Electronic Publication: 2023 Jul 07.
DOI:	10.1016/j.jtha.2023.06.034
Abstrakt:	Background: Bleeding and thrombosis are major complications of veno-venous (VV) extracorporeal membrane oxygenation (ECMO). Objectives: To assess thrombosis, major bleeding (MB), and 180-day survival in patients supported by VV-ECMO between the first (March 1 to May 31, 2020) and second (June 1, 2020, to June 30, 2021) waves of the COVID-19 pandemic. Methods: An observational study of 309 consecutive patients (aged ≥18years) with severe COVID-19 supported by VV-ECMO was performed in 4 nationally commissioned ECMO centers in the United Kingdom. Results: Median age was 48 (19-75) years, and 70.6% were male. Probabilities of survival, thrombosis, and MB at 180 days in the overall cohort were 62.5% (193/309), 39.8% (123/309), and 30% (93/309), respectively. In multivariate analysis, an age of >55 years (hazard ratio [HR], 2.29; 95% CI, 1.33-3.93; P = .003) and an elevated creatinine level (HR, 1.91; 95% CI, 1.19-3.08; P = .008) were associated with increased mortality. Correction for duration of VV-ECMO support, arterial thrombosis alone (HR, 3.0; 95% CI, 1.5-5.9; P = .002) or circuit thrombosis alone (HR, 3.9; 95% CI, 2.4-6.3; P < .001) but not venous thrombosis increased mortality. MB during ECMO had a 3-fold risk (95% CI, 2.6-5.8, P < .001) of mortality. The first wave cohort had more males (76.7% vs 64%; P = .014), higher 180-day survival (71.1% vs 53.3%; P = .003), more venous thrombosis alone (46.4% vs 29.2%; P = .02), and lower circuit thrombosis (9.2% vs 28.1%; P < .001). The second wave cohort received more steroids (121/150 [80.6%] vs 86/159 [54.1%]; P < .0001) and tocilizumab (20/150 [13.3%] vs 4/159 [2.5%]; P = .005). Conclusion: MB and thrombosis are frequent complications in patients on VV-ECMO and significantly increase mortality. Arterial thrombosis alone or circuit thrombosis alone increased mortality, while venous thrombosis alone had no effect. MB during ECMO support increased mortality by 3.9-fold. Competing Interests: Declaration of competing interests D.J.A. received funding from Bayer plc to setup the multicenter database of the study as an investigator-initiated funding. The other authors have no competing interests to disclose. (Crown Copyright © 2023. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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