Impact of major bleeding and thrombosis on 180-day survival in patients with severe COVID-19 supported with veno-venous extracorporeal membrane oxygenation in the United Kingdom: a multicentre observational study

Bleeding and thrombosis are major complications in patients supported with extracorporeal membrane oxygenation (ECMO). In this multicentre observational study of 152 consecutive patients (>= 18 years) with severe COVID-19 supported by veno-venous (VV) ECMO in four UK commissioned centres during the first wave of the COVID-19 pandemic (1 March to 31 May 2020), we assessed the incidence of major bleeding and thrombosis and their association with 180-day mortality. Median age (range) was 47 years (23-65) and 75% were male. Overall, the 180-day survival was 70 center dot 4% (107/152). The rate of major bleeding was 30 center dot 9% (47/152), of which intracranial bleeding (ICH) was 34% (16/47). There were 96 thrombotic events (63 center dot 1%) consisting of venous 44 center dot 7% [68/152 of which 66 center dot 2% were pulmonary embolism (PE)], arterial 18 center dot 6% (13/152) and ECMO circuit thrombosis 9 center dot 9% (15/152). In multivariate analysis, only raised lactate dehydrogenase (LDH) at the initiation of VV ECMO was associated with an increased risk of thrombosis [hazard ratio (HR) 1 center dot 92, 95% CI 1 center dot 21-3 center dot 03]. Major bleeding and ICH were associated with 3 center dot 87-fold (95% CI 2 center dot 10-7 center dot 23) and 5 center dot 97-fold [95% confidence interval (CI) 2 center dot 36-15 center dot 04] increased risk of mortality and PE with a 2 center dot 00-fold (95% CI1 center dot 09-3 center dot 56) risk of mortality. This highlights the difficult balancing act often encountered when managing coagulopathy in COVID-19 patients supported with ECMO.

Automated summary

Bleeding and thrombosis are common complications in patients supported with ECMO, associated with increased mortality risk. Major bleeding and intracranial bleeding increase the risk of mortality by nearly 4-fold, while pulmonary embolism increases mortality risk by 2-fold.