Dept. of Cardiovascular Surgery, Univ. Hospital Schleswig-Holstein, Kiel, Germany.
Institute of Clinical Chemistry, Univ.-Hospital Schleswig-Holstein, Kiel & Lübeck, Germany.
Blood Cells Mol Dis. 2021 Mar;87:102526. doi: 10.1016/j.bcmd.2020.102526. Epub 2020 Dec 10.
Bleeding is a common but possibly underreported side effect of Extracorporeal Membrane Oxygenation (ECMO). Impairment of primary hemostasis by acquired von Willebrand syndrome (aVWS) and platelet dysfunction as well as activation and consumption of plasmatic coagulation factors contribute to hemorrhage. The aim of the present cohort study of consecutively enrolled patients admitted to our ECMO center was to collect demographic, medical and laboratory data possibly associated with i) development of clinically relevant bleeding and/or ii) death during a 12-months follow-up.
Within a 3-year period 338 white patients aged 18-89 years (median: 60; male 64.5%) were enrolled. 78 of 338 patients (23%) presented with clinical relevant bleeding symptoms. The overall death rate was 74.6% within a median time of 9 days (1-229) post intervention. Logistic-regression analysis adjusted for age and gender revealed that i) the presence of blood group O versus non-O (Odds ratio (OR)/95%CI: 1.9/1.007-3.41), ECMO duration per day (1.1/1.06-1.14), veno-venous versus veno-arterial ECMO cannulation (2.33/1.2-4.5) and the overall need for blood product administered per unit (1.02/1.016-1.028) was independenly associated with bleeding in patients suffering from aVWS. ii) Older age (increase per year) at ECMO start (1.015/1.012-1.029) and an increasing amount of blood product units were significantly related with death (1.007/1.001-1.013). Patients with veno-venous versus veno-arterial cannulation survived longer (0.48/0.24-0.94).
In the present cohort study we found a clinical relevant bleeding rate of 23% in subjects with aVWS associated with blood group O, a longer ECMO duration and veno-venous cannulation.
出血是体外膜肺氧合（ECMO）的一种常见但可能报告不足的副作用。获得性血管性血友病（aVWS）和血小板功能障碍以及血浆凝血因子的激活和消耗导致原发性止血受损，导致出血。本研究对连续入组我院 ECMO 中心的患者进行了队列研究，收集了可能与以下因素相关的人口统计学、医学和实验室数据：i）出现临床相关出血和/或 ii）12 个月随访期间死亡。
在 3 年期间，入组了 338 名年龄在 18-89 岁之间的白人患者（中位数：60 岁；男性 64.5%）。338 例患者中有 78 例（23%）出现临床相关出血症状。中位干预后 9 天（1-229 天）内总体死亡率为 74.6%。经年龄和性别调整的逻辑回归分析显示，i）与非 O 血型相比，O 血型（比值比（OR）/95%置信区间：1.9/1.007-3.41）、ECMO 每天持续时间（1.1/1.06-1.14）、静脉-静脉与静脉-动脉 ECMO 插管（2.33/1.2-4.5）以及每单位所需的血液制品总量（1.02/1.016-1.028）与患有 aVWS 的患者出血独立相关。ii）ECMO 启动时年龄（每年增加）（1.015/1.012-1.029）和血液制品用量增加与死亡显著相关（1.007/1.001-1.013）。与静脉-动脉插管相比，静脉-静脉插管的患者存活时间更长（0.48/0.24-0.94）。
在本队列研究中，我们发现患有 aVWS 的患者临床相关出血率为 23%，与血型 O、较长的 ECMO 持续时间和静脉-静脉插管相关。
