36, 31, 38a, 45, 46
Distinguish surgical from medical bleeding: cannulation-site bleeding is common and not associated with death; ICH, pulmonary and GI haemorrhage carry the mortality signal. Minimise ECLS duration; watch renal failure, central cannulation and acidosis as bleeding risk markers.
Patients without HRAEs
DOI 10.1016/j.jchf.2020.09.004; PMID 33121701; PMC8427553
Not applicable (observational; exposure = hemocompatibility-related adverse events)
Self-reported registry; threshold-based definitions (e.g. >3 U PRBC/24 h) miss minor events and under-report; 26.1% excluded for missing data; no anticoagulation or laboratory data; no timing of events; ICD-coded comorbidities; in-hospital outcomes only; observational. Abstract lists female sex as bleeding risk factor but results describe only a trend.
8,457 HRAEs in 5,285 patients (44.1%); 62.1% bleeding, 37.9% thrombotic. Bleeding 32.8% of patients, thrombosis 17.2%. Commonest: cannulation-site 23.5%, surgical-site 20.8% of events; medical bleeding 12.6% of events; circuit clots 18.4%; ischaemic stroke 4.3% of patients, haemorrhagic stroke 2%. Crude mortality 58.6%. Adjusted OR death: 1 HRAE 1.43, 2 HRAEs 1.86, >=3 3.27. Haemorrhagic stroke 7.71, pulmonary 3.08, GI 1.95, tamponade 1.40, surgical site 1.31, cannulation site 1.05 (0.91-1.22, NS), ischaemic stroke 2.31, haemolysis 1.58. Bleeding risk: central cannulation 1.89, each day 1.06, renal failure 1.3, PMP oxygenator 1.15, older age 1.05/10y; lower with later year 0.93, higher pH 0.93/0.1, Asian race 0.8. Medical bleeding: time 1.07/day, respiratory failure 1.3, lower pH. Time on ECLS not independently associated with mortality. HRAE rates fell over time but medical bleeding (p trend 0.08) and ischaemic stroke did not.
11,984 adults on VA-ECLS in the ELSO Registry 2010-2017 (of 17,715); excluded pre-ECLS coagulopathy/DIC, GI or pulmonary bleeding, stroke, multiple runs, missing core covariates. Mean age 54.5; 44% pre-ECLS arrest; 79.3% peripheral; median 4 days.