Impact of bleeding and thrombosis on outcome of 945 COVID-19 VV-ECMO cases from a German registry
Year: 2025
Type: article
Study design: Observational Study
Abstract: Bleeding and thromboembolic events (BTE) increase the mortality of COVID-19 acute respiratory distress syndrome (ARDS) treated with extracorporeal membrane oxygenation (ECMO). The current analysis aimed to assess frequency and determinants of BTE according to their location and severity in a retrospective analysis of the German ECMO COVID-19 registry. Logistic regression was applied to identify factors influencing ICU survival as well as variables associated with risks of BTE. In total, 708 of 945 patients (75%) suffered from BTE. Overall, 1,348 events were registered, including 406 (30%) major bleeding and 258 (19%) major thromboembolic events. Most common major bleeding locations were intracranial (n = 133, 10%) and pulmonary bleeding (n = 116, 9%). In-ICU survival was 35, 46% without BTE and 22% with major bleeding (p < 0.05). In summary, major bleeding was a core outcome-determinant of COVID-19 ECMO mortality with intracranial major bleeding as the most devastating complication (OR: 5.3; CI: 2.9–9.9; p < 0.001). Neither major thromboembolism nor minor BTE impacted ICU-mortality. Potentially modifiable factors associated with major bleeding included prolonged duration of ECMO >14 days (OR: 2.9; CI 1.8–4.7; p < 0.001) and platelet counts <100.000/μL ≥ 72 h (OR: 2.0; CI 1.1–3.6; p = 0.018). Hence, prevention, early recognition and treatment of major bleedings are key to increase the survival of COVID-19 ECMO. In this regard, our data indicate that the implementation of early weaning strategies to minimize duration of ECMO therapy and prevention of prolonged thrombocytopenia with platelet counts <100.000/μl ≥ 72 h could decrease the risk of devastating bleeds and could ameliorate survival. Clinical trial registration Registered in the German Clinical Trials Register (study ID: DRKS00022964), retrospectively registered, September 7th 2020, https://drks.de/DRKS00022964 .
Source: Frontiers in Medicine
Authors: Johannes Herrmann, Janno Schade, Patrick Meybohm, Noah Paschke, Martha E. Hübsch, Quirin Notz, Julie Groene, Daniel Röder, Peter Kranke, Michaela L. Merten, Micha Landoll, Peter Spieth, Stefan Kluge, Dominik Jarczak, Kevin Roedl, Michael Sonntagbauer, Christian Putensen, Jens-Christian Schewe, Stefan F. Ehrentraut, Stefan Kreyer, Andreas Wehrfritz, Ixchel Castellanos, Karl Bihlmaier, Karsten Schmidt, Thorsten Brenner, Frank Herbstreit, Florian Espeter, Jan Wiefhoff, Richard K. Ellerkmann, Daniel Oswald, Björn Ellger, Gösta Lotz, Florian J. Raimann, Tobias Wengenmayer, Dawid L. Staudacher, Viviane Zotzmann, Onnen Moerer, Christian Kühn, Matthias Kochanek, Ralf Muellenbach, Patricia Glaser, Falk Fichtner, Marc Bodenstein, Michael Findeisen, Vanessa Rembold, Markus Heim, Gerhard Schneider, Tobias Lahmer, Jan-Sören Padberg, Carsten Hullermann, Philipp M. Lepper, Andre P. Becker, Guy Danziger, Carlos Metz, Peter Rosenberger, Valbona Mirakaj, Alice-Marie Bernard, Stephan Braune, Rebecca Roth, Anna Grau, Peter Heuschmann, Christian Karagiannidis, Christopher Lotz
Institutions: University of Würzburg, Universitätsklinikum Würzburg, Witten/Herdecke University, Kliniken der Stadt Köln, RWTH Aachen University, University Hospital Carl Gustav Carus, Technische Universität Dresden, University Medical Center Hamburg-Eppendorf, University of Bonn, University Hospital Bonn, Universitätsmedizin Rostock, University of Rostock, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Essen University Hospital, University of Duisburg-Essen, Klinikum Dortmund, Klinikum Westfalen (Germany), Goethe University Frankfurt, University Hospital Frankfurt, University of Freiburg, University Medical Center Freiburg, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Ortenau Klinikum, Universitätsmedizin Göttingen, Medizinische Hochschule Hannover, University of Cologne, University Hospital Cologne, University of Southampton, Asklepios Klinik Langen, University Hospital Leipzig, Leipzig University, University Medical Center of the Johannes Gutenberg University Mainz, Schön Klinik München Harlaching, München Klinik Harlaching, TUM Klinikum, Technical University of Munich, Ludwig-Maximilians-Universität München, University Hospital Münster, Saarland University, University of Tübingen, St. Franziskus Hospital, German Cancer Society
Language: English
Subfield: Biomedical Engineering
Field: Engineering
Domain: Physical Sciences
Open Access status: gold
Estimated APC paid: $3,801
Funders: Heart Foundation, Pfizer, Bayer, Gilead Sciences, B. Braun Melsungen, CSL Behring, Fresenius Medical Care North America, Abiomed, European Commission, Deutsche Forschungsgemeinschaft, Bundesministerium für Bildung und Forschung, Ministry of Education, Albert-Ludwigs-Universität Freiburg, Charité – Universitätsmedizin Berlin, Astellas Pharma, Shionogi, Deutsche Herzstiftung, Deutsche Krebshilfe, Ernst und Berta Grimmke Stiftung, Xenios, Stiftung Universitätsmedizin Essen, Mitsubishi Tanabe Pharma Corporation, Gemeinsame Bundesausschuss, South East Physics Network, CytoSorbents Europe, Universitätsklinikum Hamburg-Eppendorf, Daiichi Sankyo Europe
Awards: Effekt von hochdosiertem Vitamin D3 auf die 28-Tage Mortalität bei erwachsenen kritisch kranken Patienten mit schwerem Vitamin D Mangel: eine multizentrische, Placebo-kontrollierte, doppelblinde Phase III Studie, G2240775772, G2855878215, G3809929329, G4510433978, G7578079922, Nationales Forschungsnetzwerk der Universitätsmedizin zu Covid-19
OpenAlex ID: W4413365689