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. 2023 Apr 3;63(4):ezad072.
doi: 10.1093/ejcts/ezad072.

Bleeding and thrombotic events in post-cardiotomy extracorporeal life support

Anne-Kristin Schaefer  1 , Michaela Latus  1 , Julia Riebandt  1 , Georg Goliasch  2 , Martin H Bernardi  3 , Günther Laufer  1 , Daniel Zimpfer  1 , Dominik Wiedemann  1
Affiliations

Bleeding and thrombotic events in post-cardiotomy extracorporeal life support

Anne-Kristin Schaefer et al. Eur J Cardiothorac Surg. .

Abstract

Objectives: Haemorrhagic and thrombotic complications are known obstacles in extracorporeal life support (ECLS), and patients requiring post-cardiotomy (PC)-ECLS are particularly prone. The objective of this study was to characterize the incidence, type and clinical relevance of bleeding and thrombotic events in patients on PC-ECLS.

Methods: A total of 504 patients receiving PC-ECLS between 2000 and 2021 at a single centre were included in a retrospective analysis. Incidence and type of haemorrhagic and thrombotic complications in patients on PC-ECLS were assessed. Overall survival was compared, and perioperative risk factors for bleeding and thrombotic events were assessed by binary logistic regression.

Results: Of the 504 patients requiring PC-ECLS, 196 patients (38.9%) had 235 bleeding events [surgical site: n = 135 (26.8%); cannulation site: n = 68(13.4%); requiring surgical revision: n = 39 (7.7%); cannulation site change: n = 17 (3.4%); fatal cannulation site bleeding: n = 4(0.8%); intracranial haemorrhage: n = 11 (2.1%); gastrointestinal haemorrhage: n = 8 (1.6%); pulmonary haemorrhage: n = 8 (1.6%); and intra-abdominal/retroperitoneal haemorrhage: n = 5 (1%)]. Overall mortality was higher in patients with major bleeding complications than in patients without bleeding complications (P < 0.0001).A total of 74 patients (14.7%) had 84 thrombotic events [ischaemic stroke, n = 39 (7.7%); cannula/circuit thrombosis, n = 26 (5.2%); peripheral embolism, n = 11 (2.2%); device exchange for haemolysis, n = 8 (1.6%)]. Another 246 patients (48.8%) had at least 1 haemocompatibility-related adverse event. Preoperative dual antiplatelet therapy [adjusted odds ratio (OR): 1.83, 95% confidence interval (CI): 1.063-3.137] and ECLS duration (adjusted OR: 1.14, 95% CI: 1.086-1.197) were identified as independent risk factors for haemorrhage. Prior stroke/transient ischaemic attack (adjusted OR: 1.91, 95% CI: 1.08-3.83) and ECLS duration (adjusted OR: 1.09, 95% CI: 1.04-1.15) were identified as risk factors for thrombotic events.

Conclusions: Bleeding complications in patients on ECLS are common and significantly impair survival. Nearly half of the patients were affected by any haemocompatibility-related event.

Keywords: bleeding in ECLS; extracorporeal membrane oxygenation; post-cardiotomy extracorporeal life support.

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Figures

Figure 1:
Figure 1:
Study flow chart.
Figure 2:
Figure 2:
Overview of haemocompatibility-related adverse events.
Figure 3:
Figure 3:
(A) Kaplan–Meier estimates of survival of patients on post-cardiotomy extracorporeal life support with and without haemorrhagic events. Overall mortality was significantly higher in patients on extracorporeal life support who had one or more bleeding events compared to patients on extracorporeal life support without bleeding events (shaded areas = 95% confidence interval). (B) Kaplan-Meier estimates of survival of patients with no haemocompatibility-related adverse events (n=258), bleeding events only (n=172), thrombotic events only (n=50) or both (n=24).
None
See this image and copyright information in PMC

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