. 2022 Aug;48(8):1039-1052.

doi: 10.1007/s00134-022-06794-y. Epub 2022 Jul 13.

Bleeding and thrombotic events in patients with severe COVID-19 supported with extracorporeal membrane oxygenation: a nationwide cohort study

Alexandre Mansour^{1

2

3}, Erwan Flecher⁴, Matthieu Schmidt^{5

6}, Bertrand Rozec^{7

8}, Isabelle Gouin-Thibault^{9

10}, Maxime Esvan^{11

12}, Claire Fougerou^{11

12}, Bruno Levy^{13

14

15}, Alizée Porto¹⁶, James T Ross¹⁷, Marylou Para^{18

19}, Sabrina Manganiello²⁰, Guillaume Lebreton^{6

21}, André Vincentelli^{20

22}, Nicolas Nesseler^{23

9

24}; ECMOSARS Investigators

Collaborators, Affiliations

Collaborators

ECMOSARS Investigators:
Marc Pierrot, Sidney Chocron, Guillaume Flicoteaux, Philippe Mauriat, Alexandre Ouattara, Hadrien Roze, Olivier Huet, Marc-Olivier Fischer, Claire Alessandri, Raphel Bellaïche, Ophélie Constant, Quentin de Roux, André Ly, Arnaud Meffert, Jean-Claude Merle, Nicolas Mongardon, Lucile Picard, Elena Skripkina, Thierry Folliguet, Antonio Fiore, Nicolas D'ostrevy, Marie-Catherine Morgan, Pierre-Grégoire Guinot, Maxime Nguyen, Lucie Gaide-Chevronnay, Nicolas Terzi, Gwenhaël Colin, Olivier Fabre, Arash Astaneh, Justin Issard, Elie Fadel, Dominique Fabre, Antoine Girault, Julien Guihaire, Iolande Ion, Jean Baptiste Menager, Delphine Mitilian, Olaf Mercier, François Stephan, Jacques Thes, Jerôme Jouan, Thibault Duburcq, Valentin Loobuyck, Mouhammed Moussa, Agnes Mugnier, Natacha Rousse, Olivier Desebbe, Jean-Luc Fellahi, Roland Henaine, Matteo Pozzi, Jean-Christophe Richard, Zakaria Riad, Christophe Guervilly, Sami Hraiech, Laurent Papazian, Matthias Castanier, Charles Chanavaz, Cyril Cadoz, Sebastien Gette, Guillaume Louis, Erick Portocarrero, Philippe Gaudard, Kais Brini, Nicolas Bischoff, Antoine Kimmoun, Mathieu Mattei, Pierre Perez, Alexandre Bourdiol, Yannick Hourmant, Pierre-Joachim Mahé, Pierre Jaquet, Brice Lortat-Jacob, Pierre Mordant, Patrick Nataf, Juliette Patrier, Sophie Provenchère, Morgan Roué, Romain Sonneville, Alexy Tran-Dinh, Paul-Henri Wicky, Charles Al Zreibi, Bernard Cholley, Yannis Guyonvarch, Sophie Hamada, Anatole Harrois, Jordi Matiello, Thomas Kerforne, Corentin Lacroix, Nicolas Brechot, Alain Combes, Juliette Chommeloux, Jean Michel Constantin, Cosimo D'alessandro, Pierre Demondion, Alexandre Demoule, Martin Dres, Guillaume Fadel, Muriel Fartoukh, Guillaume Hekimian, Charles Juvin, Pascal Leprince, David Levy, Charles Edouard Luyt, Marc Pineton De Chambrun, Thibaut Schoell, Pierre Fillâtre, Nicolas Massart, Roxane Nicolas, Maud Jonas, Charles Vidal, Nicolas Allou, Salvatore Muccio, Dario Di Perna, Vito-Giovanni Ruggieri, Bruno Mourvillier, Amedeo Anselmi, Karl Bounader, Yoann Launey, Thomas Lebouvier, Alessandro Parasido, Florian Reizine, Philippe Seguin, Emmanuel Besnier, Dorothée Carpentier, Thomas Clavier, Pierre-Emmanuel Falcoz, Anne Olland, Marion Villard, Fanny Bounes, François Labaste, Vincent Minville, Antoine Guillon, Yannick Fedun

Affiliations

¹ Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Rennes, France. alexandre.mansour@chu-rennes.fr.
² Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), 35000, Rennes, France. alexandre.mansour@chu-rennes.fr.
³ Hôpital Pontchaillou, Pôle Anesthésie, SAMU, Urgences, Réanimations, Médecine Interne et Gériatrie (ASUR-MIG), 2 rue Henri Le Guilloux, 35033, Rennes Cedex 9, France. alexandre.mansour@chu-rennes.fr.
⁴ Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, University of Rennes 1, Signal and Image Treatment Laboratory (LTSI), Inserm U1099, Rennes, France.
⁵ Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013, Paris, France.
⁶ Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, 75013, Paris, France.
⁷ Cardiothoracic and Cardiovascular Intensive Care Unit, Laennec University Hospital, Saint-Herblain, France.
⁸ Institut du Thorax, Institut National de la Santé et de la Recherche Médicale UMR1087 IRT, Paris, France.
⁹ Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), 35000, Rennes, France.
¹⁰ Department of Hematology, Pontchaillou, University Hospital of Rennes, Rennes, France.
¹¹ Department of Clinical Pharmacology, University Hospital, Rennes 1 University, 35033, Rennes, France.
¹² Inserm CIC 1414, Clinical Investigation Centre, University Hospital, Rennes 1 University, 35033, Rennes, France.
¹³ Médecine Intensive Et Réanimation, CHRU Nancy, Pôle Cardio-Médico-Chirurgical, 54511, Vandœuvre-lès-Nancy, France.
¹⁴ INSERM U1116, Faculté de Médecine, 54511, Vandoeuvre-lès-Nancy, France.
¹⁵ Université de Lorraine, 54000, Nancy, France.
¹⁶ Department of Cardiac Surgery, Timone Hospital, APHM, 13005, Marseille, France.
¹⁷ Department of Surgery, University of California Davis, Sacramento, USA.
¹⁸ Department of Cardiovascular Surgery and Transplantation, Bichat Hospital, AP-HP, Paris, France.
¹⁹ University of Paris, UMR 1148, Laboratory of Vascular Translational Science, Paris, France.
²⁰ Univ. Lille, CHU Lille, Cardiac Surgery, 59000, Lille, France.
²¹ Service de Chirurgie Thoracique et Cardiovasculaire, Institut de Cardiologie, APHP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France.
²² Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, 59000, Lille, France.
²³ Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Rennes, France.
²⁴ Univ Rennes, CHU de Rennes, Inra, Inserm, Institut NUMECAN-UMR_A 1341, UMR_S 1241, 35000, Rennes, France.

PMID: 35829723
DOI: 10.1007/s00134-022-06794-y

Bleeding and thrombotic events in patients with severe COVID-19 supported with extracorporeal membrane oxygenation: a nationwide cohort study

Alexandre Mansour et al. Intensive Care Med. 2022 Aug.

. 2022 Aug;48(8):1039-1052.

doi: 10.1007/s00134-022-06794-y. Epub 2022 Jul 13.

Authors

Collaborators

ECMOSARS Investigators:
Marc Pierrot, Sidney Chocron, Guillaume Flicoteaux, Philippe Mauriat, Alexandre Ouattara, Hadrien Roze, Olivier Huet, Marc-Olivier Fischer, Claire Alessandri, Raphel Bellaïche, Ophélie Constant, Quentin de Roux, André Ly, Arnaud Meffert, Jean-Claude Merle, Nicolas Mongardon, Lucile Picard, Elena Skripkina, Thierry Folliguet, Antonio Fiore, Nicolas D'ostrevy, Marie-Catherine Morgan, Pierre-Grégoire Guinot, Maxime Nguyen, Lucie Gaide-Chevronnay, Nicolas Terzi, Gwenhaël Colin, Olivier Fabre, Arash Astaneh, Justin Issard, Elie Fadel, Dominique Fabre, Antoine Girault, Julien Guihaire, Iolande Ion, Jean Baptiste Menager, Delphine Mitilian, Olaf Mercier, François Stephan, Jacques Thes, Jerôme Jouan, Thibault Duburcq, Valentin Loobuyck, Mouhammed Moussa, Agnes Mugnier, Natacha Rousse, Olivier Desebbe, Jean-Luc Fellahi, Roland Henaine, Matteo Pozzi, Jean-Christophe Richard, Zakaria Riad, Christophe Guervilly, Sami Hraiech, Laurent Papazian, Matthias Castanier, Charles Chanavaz, Cyril Cadoz, Sebastien Gette, Guillaume Louis, Erick Portocarrero, Philippe Gaudard, Kais Brini, Nicolas Bischoff, Antoine Kimmoun, Mathieu Mattei, Pierre Perez, Alexandre Bourdiol, Yannick Hourmant, Pierre-Joachim Mahé, Pierre Jaquet, Brice Lortat-Jacob, Pierre Mordant, Patrick Nataf, Juliette Patrier, Sophie Provenchère, Morgan Roué, Romain Sonneville, Alexy Tran-Dinh, Paul-Henri Wicky, Charles Al Zreibi, Bernard Cholley, Yannis Guyonvarch, Sophie Hamada, Anatole Harrois, Jordi Matiello, Thomas Kerforne, Corentin Lacroix, Nicolas Brechot, Alain Combes, Juliette Chommeloux, Jean Michel Constantin, Cosimo D'alessandro, Pierre Demondion, Alexandre Demoule, Martin Dres, Guillaume Fadel, Muriel Fartoukh, Guillaume Hekimian, Charles Juvin, Pascal Leprince, David Levy, Charles Edouard Luyt, Marc Pineton De Chambrun, Thibaut Schoell, Pierre Fillâtre, Nicolas Massart, Roxane Nicolas, Maud Jonas, Charles Vidal, Nicolas Allou, Salvatore Muccio, Dario Di Perna, Vito-Giovanni Ruggieri, Bruno Mourvillier, Amedeo Anselmi, Karl Bounader, Yoann Launey, Thomas Lebouvier, Alessandro Parasido, Florian Reizine, Philippe Seguin, Emmanuel Besnier, Dorothée Carpentier, Thomas Clavier, Pierre-Emmanuel Falcoz, Anne Olland, Marion Villard, Fanny Bounes, François Labaste, Vincent Minville, Antoine Guillon, Yannick Fedun

Affiliations

¹ Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Rennes, France. alexandre.mansour@chu-rennes.fr.
² Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), 35000, Rennes, France. alexandre.mansour@chu-rennes.fr.
³ Hôpital Pontchaillou, Pôle Anesthésie, SAMU, Urgences, Réanimations, Médecine Interne et Gériatrie (ASUR-MIG), 2 rue Henri Le Guilloux, 35033, Rennes Cedex 9, France. alexandre.mansour@chu-rennes.fr.
⁴ Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, University of Rennes 1, Signal and Image Treatment Laboratory (LTSI), Inserm U1099, Rennes, France.
⁵ Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013, Paris, France.
⁶ Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, 75013, Paris, France.
⁷ Cardiothoracic and Cardiovascular Intensive Care Unit, Laennec University Hospital, Saint-Herblain, France.
⁸ Institut du Thorax, Institut National de la Santé et de la Recherche Médicale UMR1087 IRT, Paris, France.
⁹ Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), 35000, Rennes, France.
¹⁰ Department of Hematology, Pontchaillou, University Hospital of Rennes, Rennes, France.
¹¹ Department of Clinical Pharmacology, University Hospital, Rennes 1 University, 35033, Rennes, France.
¹² Inserm CIC 1414, Clinical Investigation Centre, University Hospital, Rennes 1 University, 35033, Rennes, France.
¹³ Médecine Intensive Et Réanimation, CHRU Nancy, Pôle Cardio-Médico-Chirurgical, 54511, Vandœuvre-lès-Nancy, France.
¹⁴ INSERM U1116, Faculté de Médecine, 54511, Vandoeuvre-lès-Nancy, France.
¹⁵ Université de Lorraine, 54000, Nancy, France.
¹⁶ Department of Cardiac Surgery, Timone Hospital, APHM, 13005, Marseille, France.
¹⁷ Department of Surgery, University of California Davis, Sacramento, USA.
¹⁸ Department of Cardiovascular Surgery and Transplantation, Bichat Hospital, AP-HP, Paris, France.
¹⁹ University of Paris, UMR 1148, Laboratory of Vascular Translational Science, Paris, France.
²⁰ Univ. Lille, CHU Lille, Cardiac Surgery, 59000, Lille, France.
²¹ Service de Chirurgie Thoracique et Cardiovasculaire, Institut de Cardiologie, APHP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France.
²² Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, 59000, Lille, France.
²³ Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Rennes, France.
²⁴ Univ Rennes, CHU de Rennes, Inra, Inserm, Institut NUMECAN-UMR_A 1341, UMR_S 1241, 35000, Rennes, France.

PMID: 35829723
DOI: 10.1007/s00134-022-06794-y

Abstract

Purpose: To describe bleeding and thrombotic events and their risk factors in patients receiving extracorporeal membrane oxygenation (ECMO) for severe coronavirus disease 2019 (COVID-19) and to evaluate their impact on in-hospital mortality.

Methods: The ECMOSARS registry included COVID-19 patients supported by ECMO in France. We analyzed all patients included up to March 31, 2022 without missing data regarding bleeding and thrombotic events. The association of bleeding and thrombotic events with in-hospital mortality and pre-ECMO variables was assessed using multivariable logistic regression models.

Results: Among 620 patients supported by ECMO, 29% had only bleeding events, 16% only thrombotic events and 20% both bleeding and thrombosis. Cannulation site (18% of patients), ear nose and throat (12%), pulmonary bleeding (9%) and intracranial hemorrhage (8%) were the most frequent bleeding types. Device-related thrombosis and pulmonary embolism/thrombosis accounted for most of thrombotic events. In-hospital mortality was 55.7%. Bleeding events were associated with in-hospital mortality (adjusted odds ratio (adjOR) = 2.91[1.94-4.4]) but not thrombotic events (adjOR = 1.02[0.68-1.53]). Intracranial hemorrhage was strongly associated with in-hospital mortality (adjOR = 13.5[4.4-41.5]). Ventilation duration before ECMO ≥ 7 days and length of ECMO support were associated with bleeding. Thrombosis-associated factors were fibrinogen ≥ 6 g/L and length of ECMO support.

Conclusions: In a nationwide cohort of COVID-19 patients supported by ECMO, bleeding incidence was high and associated with mortality. Intracranial hemorrhage incidence was higher than reported for non-COVID patients and carried the highest risk of death. Thrombotic events were less frequent and not associated with mortality. Length of ECMO support was associated with a higher risk of both bleeding and thrombosis, supporting the development of strategies to minimize ECMO duration.

Trial registration: ClinicalTrials.gov NCT04397588.

Keywords: Anticoagulation; Bleeding; COVID-19; ECMO; Thrombosis.

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Comment in

Bleeding and clotting while supported with ECMO: time to move forward.
Pratt EH, Stokes JW, Fan E. Pratt EH, et al. Intensive Care Med. 2022 Aug;48(8):1059-1061. doi: 10.1007/s00134-022-06805-y. Epub 2022 Jul 13. Intensive Care Med. 2022. PMID: 35829722 No abstract available.

References

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Bleeding and thrombotic events in patients with severe COVID-19 supported with extracorporeal membrane oxygenation: a nationwide cohort study

Collaborators

Affiliations

Bleeding and thrombotic events in patients with severe COVID-19 supported with extracorporeal membrane oxygenation: a nationwide cohort study

Authors

Collaborators

Affiliations

Abstract

Comment in

References

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Medical