36, 31, 38a, 45, 9
On VV-ECMO thrombotic events are more common but bleeding carries more mortality, especially medical bleeding; AKI and vasopressors before ECMO flag bleeding risk; avoid large early PaO2 rises; minimise duration.
Patients without BTEs
DOI 10.1007/s00134-021-06593-x; PMID 34921625; PMC9178906 (correction PMID 35041017)
Not applicable (observational; exposure = bleeding and thrombotic events)
Registry; missing-data exclusions; no VTE, DVT, PE or upper respiratory bleeding collected; no anticoagulation or laboratory data; no event timing; ICD-coded comorbidities; in-hospital outcomes only; observational.
40.2% had >=1 BTE; of these 41.7% thrombosis only, 37% bleeding only, 21.2% both. Of 4,840 BTEs, 54.9% thrombotic: circuit clotting 31.8%, oxygenator/pump failure 12.7%; cannulation bleeding 15.5%, surgical site 9.6%; medical bleeding 18.7%; ICH 4.5%, ischaemic stroke 1.9% of events. Mortality 34.9%. Adjusted OR death: any bleeding 1.69, any thrombosis 1.23; 1 BTE 1.66, 2 BTEs 1.68, >=3 2.16; ICH 5.71, ischaemic stroke 4.50, pulmonary 2.02, GI 1.54; no surgical bleeding event significant. Mortality with event: ischaemic stroke 73.9%, ICH 73.2%, pulmonary 53.6%, GI 48.6%, tamponade 46.6%, oxygenator/pump failure 45.7%, haemolysis 42.2%, surgical site 39.6%, cannula site 39.3%, circuit clotting 34.7%. Bleeding risk: pre-ECMO AKI, vasopressors, longer duration, younger age, higher pH. Thrombosis risk: higher weight, multisite cannulation, pre-ECMO arrest, higher PaCO2. Ischaemic stroke with delta PaO2 >80 mmHg at 24 h (15% higher odds per 10 mmHg); ICH with delta PaO2 <80.
7,579 adults on VV-ECMO in the ELSO Registry 2010-2017 (of 11,880); exclusions as companion VA study. Mean age 46.5; median 8 days; single-site cannulation 36.7%. Intensive Care Med 2022;48(2):213-224 (online Dec 2021).