Advanced Medical Emergency Department & Critical Care Center, Japanese Red Cross Maebashi Hospital, Maebashi, Japan.
Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia.
Artif Organs. 2022 Sep;46(9):1901-1911. doi: 10.1111/aor.14267. Epub 2022 Apr 29.
Bleeding complications during venovenous extracorporeal membrane oxygenation (V-V ECMO) can be critical. However, there is limited information on the associated risk factors. This study investigated the risk factors for bleeding complications during V-V ECMO as a bridge to recovery.
This single-center retrospective study enrolled 59 patients (bleeding and non-bleeding groups) who received V-V ECMO from 2012 to 2020, to evaluate whether peak activated partial thromboplastin time (APTT) value, lowest platelet count, and mobilization to sitting on the edge of the bed during V-V ECMO were risk factors for bleeding complications, defined according to the Extracorporeal Life Support Organization guidelines. Age, sex, body mass index, Sequential Organ Failure Assessment score, and ECMO duration before bleeding complications were covariates in the multivariate logistic regression analysis.
Thirty-one (53%) participants experienced 36 bleeding complications; the ECMO cannulation site, gastrointestinal tract, and nasopharyngeal region were the most common bleeding sites. The use of transfusion products and length of ECMO and intensive care unit stay were significantly and medical costs were non-significantly increased in the bleeding group. Peak APTT (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01-1.05, p < 0.01) was significantly associated whereas the lowest platelet count (OR 0.96, 95% CI 0.82-1.13, p = 0.66) was unassociated with bleeding complications during ECMO. Achieving mobilization (OR 0.14, 95% CI 0.02-1.17, p = 0.07) decreased the trend of risk for bleeding complications.
Peak APTT might be an independent modifiable factor for bleeding complications during V-V ECMO. The protective effect of mobilization during V-V ECMO requires further investigation.
静脉-静脉体外膜肺氧合（V-V ECMO）期间的出血并发症可能是关键的。然而，关于相关危险因素的信息有限。本研究调查了 V-V ECMO 期间出血并发症的危险因素，作为恢复的桥梁。
这项单中心回顾性研究纳入了 2012 年至 2020 年期间接受 V-V ECMO 的 59 名患者（出血组和非出血组），以评估 V-V ECMO 期间的峰值激活部分凝血活酶时间（APTT）值、最低血小板计数和向床边移动是否为出血并发症的危险因素，根据体外生命支持组织指南进行定义。年龄、性别、体重指数、序贯器官衰竭评估评分和出血并发症前的 ECMO 持续时间是多变量逻辑回归分析的协变量。
31 名（53%）患者发生 36 次出血并发症；最常见的出血部位是 ECMO 插管部位、胃肠道和鼻咽部。出血组的输血产品使用、ECMO 和重症监护病房的住院时间显著增加，医疗费用非显著增加。峰值 APTT（比值比[OR]1.03，95%置信区间[CI]1.01-1.05，p<0.01）与出血并发症显著相关，而最低血小板计数（OR 0.96，95%CI 0.82-1.13，p=0.66）与 ECMO 期间的出血并发症无关。实现移动（OR 0.14，95%CI 0.02-1.17，p=0.07）降低了出血并发症的风险趋势。
峰值 APTT 可能是 V-V ECMO 期间出血并发症的一个独立可调节因素。V-V ECMO 期间移动的保护作用需要进一步研究。
