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Observational Study
. 2022 Jun 1;50(6):e569-e580.
doi: 10.1097/CCM.0000000000005466. Epub 2022 Feb 3.

Longitudinal Trends in Bleeding Complications on Extracorporeal Life Support Over the Past Two Decades-Extracorporeal Life Support Organization Registry Analysis

Anne Willers  1 , Justyna Swol  2 , Hergen Buscher  3   4 , Zoe McQuilten  5 , Sander M J van Kuijk  6 , Hugo Ten Cate  7   8 , Peter T Rycus  9 , Stephen McKellar  10   11 , Roberto Lorusso  1   8 , Joseph E Tonna  10   11
Affiliations
Observational Study

Longitudinal Trends in Bleeding Complications on Extracorporeal Life Support Over the Past Two Decades-Extracorporeal Life Support Organization Registry Analysis

Anne Willers et al. Crit Care Med. .

Abstract

Objectives: Data about inhospital outcomes in bleeding complications during extracorporeal life support (ECLS) have been poorly investigated.

Design: Retrospective observational study.

Setting: Patients reported in Extracorporeal Life Support Organization Registry.

Patients: Data of 53.644 adult patients (greater than or equal to 18 yr old) mean age 51.4 ± 15.9 years, 33.859 (64.5%) male supported with single ECLS run between 01.01.2000 and 31.03.2020, and 19.748 cannulated for venovenous (V-V) ECLS and 30.696 for venoarterial (V-A) ECLS.

Interventions: Trends in bleeding complications, bleeding risk factors, and mortality.

Measurement and main results: Bleeding complications were reported in 14.786 patients (27.6%), more often in V-A ECLS compared with V-V (30.0% vs 21.9%; p < 0.001). Hospital survival in those who developed bleeding complications was lower in both V-V ECLS (49.6% vs 66.6%; p < 0.001) and V-A ECLS (33.9 vs 44.9%; p < 0.001). Steady decrease in bleeding complications in V-V and V-A ECLS was observed over the past 20 years (coef., -1.124; p < 0.001 and -1.661; p < 0.001). No change in mortality rates was reported over time in V-V or V-A ECLS (coef., -0.147; p = 0.442 and coef., -0.195; p = 0.139).Multivariate regression revealed advanced age, ecls duration, surgical cannulation, renal replacement therapy, prone positioning as independent bleeding predictors in v-v ecls and female gender, ecls duration, pre-ecls arrest or bridge to transplant, therapeutic hypothermia, and surgical cannulation in v-a ecls.

Conclusions: A steady decrease in bleeding over the last 20 years, mostly attributable to surgical and cannula-site-related bleeding has been found in this large cohort of patients receiving ECLS support. However, there is not enough data to attribute the decreasing trends in bleeding to technological refinements alone. Especially reduction in cannulation site bleeding is also due to changes in timing, patient selection, and ultrasound guided percutaneous cannulation. Other types of bleeding, such as CNS, have remained stable, and overall bleeding remains associated with a persistent increase in mortality.

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Conflict of interest statement

Prof. Lorusso is a consultant for Medtronic, Getinge, and LivaNova and medical advisory board member for Eurosets, all unrelated to this work; all honoraria to the university for research funding. Dr. Tonna is supported by a Career Development Award from the National Institutes of Health (NIH)/National Heart, Lung, And Blood Institute (K23 HL141596). Dr. Tonna received speaker fees and travel compensation from LivaNova and Philips Healthcare, unrelated to this work. He disclosed that he is the Chair of the Extracorporeal Life Support Organization Registry Scientific Oversight Committee; he received support for article research from the NIH; and he disclosed the off-label product use of ECMO for >6 hours. Prof. ten Cate received research support from Bayer and Pfizer and is a consultant for Alveron and stockholder with Coagulation Profile; all unrelated to this work. Zoe McQuilten is supported by an Australian National Health andMedical Council Investigator Grant. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Bleeding complications trends in the past two decades in the overall cohort
Figure 2.
Figure 2.
Indexed temporal trends of bleeding complications in the veno-venous and veno-arterial extracorporeal life support groups.
Figure 3.
Figure 3.
Mortality of bleeding and non-bleeding patients in veno-venous and veno-arterial extracorporeal life support patients over the past two decades.
See this image and copyright information in PMC

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