Background: Complications during veno-venous extracorporeal membrane oxygenation (VV-ECMO) are associated with in-hospital mortality. Asian patients on extracorporeal membrane oxygenation (ECMO) have a higher risk of bleeding and in-hospital mortality than Caucasian patients. This study aimed to characterise and identify bleeding complications and their associated factors related to in-hospital mortality in patients with severe COVID-19 requiring VV-ECMO in Japan.
Methods: In this retrospective observational analysis, the prospective nationwide multicentre registry was used to track real-time information from intensive care units throughout Japan during the COVID-19 pandemic. VV-ECMO patients' registry data between February 1, 2020, and October 31, 2022, were used.
Results: This study included a total of 441 patients; 178 (40%) had bleeding complications in the following sites: 20% at the cannulation site, 16% in the gastrointestinal tract, 16% in the ear-nose-throat, 13% at the tracheostomy site, 9% intrathoracic, 6% intracranial, and 5%, in the iliopsoas. Anticoagulation was discontinued in >50% of patients with intracranial, iliopsoas, and gastrointestinal tract bleeding. ECMO was discontinued in one-third of patients with intracranial, intramuscular, and iliopsoas haemorrhages. Multivariable logistic regression analysis revealed that only gastrointestinal tract bleeding was associated with in-hospital mortality (odds ratio: 2.49; 95% confidence interval: 1.11-5.60; P=0.03).
Conclusions: Bleeding complication incidence was 40% in the Japanese population. Gastrointestinal tract bleeding emerged as a significant predictor of adverse outcomes, necessitating further research into preventive strategies and optimised care protocols. The study findings can help inform the management of VV-ECMO patients with COVID-19.
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