Bleeding and Thrombotic Complications in COVID-19-Associated ARDS Requiring ECMO

Autores da FMUP

• Roberto Liberal Fernandes Roncon Albuquerque

  Autor

Participantes de fora da FMUP

• Tavares, EP
• Rebolo, JR
• Pimentel, R

Unidades de investigação

• Cirurgia e Fisiologia

• Laboratório Associado RISE- Rede de Investigação em Saúde

  

  Investigador

  Fernando Carlos De Landér Schmitt

• RISE-Health

  

  Investigador

  Fernando Carlos De Landér Schmitt

Abstract

BACKGROUND: We analyzed bleeding and thrombotic complications in COVID-19-associated ARDS requiring extracorporeal membrane oxygenation (ECMO). METHODS: This was a single-center observational study of adult subjects undergoing ECMO for COVID-19 (n = 67) or all other cause of ARDS (n = 60), excluding trauma patients. RESULTS: In the COVID-19 group, duration of invasive mechanical ventilation prior to ECMO was lower (2 [0-4] d vs 3 [1-6] d) and ECMO retrieval less frequent (71% vs 87%). No significant differences were found in Simplified Acute Physiology Score II, Acute Physiology and Chronic Health Evaluation II (APACHE II), or in the in-hospital survival predicted by the Respiratory ECMO Survival Prediction score. During the first 7 d of ECMO support, the COVID-19 group presented higher platelets and fibrinogen, lower activated partial thromboplastin time, but no differences in D-dimer. Thrombotic complications were similar between groups. Higher rates of severe bleeding, namely airway bleeding (37.3% vs 15.0%) and hemothorax (13.4% vs 3.3%), were found in COVID-19, with lower hemoglobin and higher red blood cell transfusions. COVID-19 ARDS was associated with longer ECMO duration (47 [17-80] d vs 19 [12-30] d) and absence of a statistically significant difference concerning in-hospital mortality. CONCLUSIONS: COVID-19-associated ARDS requiring ECMO presented high rates of severe bleeding complications and a protracted course. Further studies are needed to clarify the risks and benefits of ECMO in severe COVID-19-associated ARDS.

Keywords

• Adult; COVID-19; Extracorporeal Membrane Oxygenation; Humans; Respiratory Distress Syndrome; Retrospective Studies; Treatment Outcome; D dimer; fibrinogen; hemoglobin; heparin; activated partial thromboplastin time; adult respiratory distress syndrome; anticoagulant therapy; APACHE; Article; bacterial pneumonia; bronchoscopy; cannulation; coronavirus disease 2019; diabetes mellitus; extracorporeal oxygenation; heart arrest; hematothorax; hematuria; hemorrhagic shock; Horowitz index; hypertension; nasopharyngeal swab; obesity; polymerase chain reaction; positive end expiratory pressure ventilation; respiratory failure; Simplified Acute Physiology Score; smoking; thrombosis; tidal volume; virus pneumonia; weaning; adult; complication; human; respiratory distress syndrome; retrospective study; treatment outcome