Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK.
Department of Respiratory Medicine, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK.
Int J Artif Organs. 2022 Feb;45(2):239-242. doi: 10.1177/0391398821989065. Epub 2021 Jan 28.
COVID-19 has been associated with increased risk of thrombosis, heparin resistance and coagulopathy in critically ill patients admitted to intensive care. We report the incidence of thrombotic and bleeding events in a single center cohort of 30 consecutive patients with COVID-19 supported by veno-venous extracorporeal oxygenation (ECMO) and who had a whole body Computed Tomography Scanner (CT) on admission.
All patients were initially admitted to other hospitals and later assessed and retrieved by our ECMO team. ECMO was initiated in the referral center and all patients admitted through our CT scan before settling in our intensive care unit. Clinical management was guided by our institutional ECMO guidelines, established since 2011 and applied to at least 40 patients every year.
We diagnosed a thrombotic event in 13 patients on the initial CT scan. Two of these 13 patients subsequently developed further thrombotic complications. Five of those 13 patients had a subsequent clinically significant major bleeding. In addition, two patients presented with isolated intracranial bleeds. Of the 11 patients who did not have baseline thrombotic events, one had a subsequent oropharyngeal hemorrhage. When analyzed by ROC analysis, the area under the curve for % time in intended anticoagulation range did not predict thrombosis or bleeding during the ECMO run (0.36 (95% CI 0.10-0.62); and 0.51 (95% CI 0.25-0.78); respectively).
We observed a high prevalence of VTE and a significant number of hemorrhages in these severely ill patients with COVID-19 requiring veno-venous ECMO support.
COVID-19 与重症监护病房中接受静脉-静脉体外膜肺氧合 (ECMO) 支持的危重病患者的血栓形成、肝素抵抗和凝血病风险增加有关。我们报告了在我们的 ECMO 团队支持的 30 例连续 COVID-19 患者的单中心队列中，血栓形成和出血事件的发生率，这些患者在入院时进行了全身计算机断层扫描 (CT) 检查。
所有患者最初均被收入其他医院，随后由我们的 ECMO 团队进行评估和回收。ECMO 在转诊中心启动，所有患者在入住我们的重症监护病房之前都通过我们的 CT 扫描进行了评估。临床管理由我们自 2011 年以来制定的机构 ECMO 指南指导，每年至少应用于 40 名患者。
我们在初始 CT 扫描中诊断出 13 例患者存在血栓形成事件。这 13 例患者中的 2 例随后出现了进一步的血栓并发症。这 13 例患者中有 5 例随后出现了临床上明显的大出血。此外，有 2 例患者出现孤立性颅内出血。在 11 例没有基线血栓形成事件的患者中，有 1 例出现了随后的口咽部出血。通过 ROC 分析，%时间处于预期抗凝范围内的曲线下面积不能预测 ECMO 运行期间的血栓形成或出血（0.36（95%CI 0.10-0.62）；0.51（95%CI 0.25-0.78））。
我们观察到，需要静脉-静脉 ECMO 支持的 COVID-19 重症患者中，VTE 患病率较高，且大量患者发生出血。
