Goto Kazuki, Takayama Yukihisa, Honda Gaku, Fujita Kazuaki, Osame Akinobu, Urakawa Hiroshi, Hoshino Kota, Nakamura Yoshihiko, Ishikura Hiroyasu, Yoshimitsu Kengo
Department of Radiology, Faculty of Medicine, Fukuoka University, Japan.
Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, Japan.
Interv Radiol (Higashimatsuyama). 2023 Sep 21;8(3):136-145. doi: 10.22575/interventionalradiology.2022-0043. eCollection 2023 Nov 1.
To evaluate risk factors for bleeding events in coronavirus disease 2019 (COVID-19) patients on extracorporeal membrane oxygenation (ECMO) and to share the initial results of transcatheter arterial embolization (TAE) for hemostasis.
Forty-three COVID-19 patients who received ECMO from May 2020 to September 2021 were enrolled in this study. Patients with sudden onset anemia immediately underwent computed tomography to assess bleeding. We compared laboratory data, duration of ECMO, hospitalization period, and fatality of patients' groups with and without significant hemorrhagic events using the chi-square test and Mann-Whitney test. We also assessed the results of TAE in patients who received hemostasis.
A total of 25 bleeding events occurred in 24 of the 43 patients. Age was a risk factor for bleeding events and fatality. The average duration of ECMO and hospitalization period were significantly longer in those with bleeding events (42.9 and 54.3 days) than in those without bleeding events (16.2 and 25.0 days) (p < 0.05). In addition, those with bleeding had higher fatality (45.8%) than those without (15.8%) (p < 0.05). Active extravasation was confirmed for 5 events in 4 of 24 patients. TAE was attempted and performed successfully in all but one of these four cases, in whom bleeding ceased spontaneously.
Elderly COVID-19 patients on ECMO had a greater risk of bleeding complications and fatal outcomes. TAE was effective in providing prompt hemostasis for patients who have the treatment indication.
评估接受体外膜肺氧合（ECMO）治疗的2019冠状病毒病（COVID-19）患者发生出血事件的危险因素，并分享经导管动脉栓塞术（TAE）止血的初步结果。
本研究纳入了2020年5月至2021年9月期间接受ECMO治疗的43例COVID-19患者。突发贫血的患者立即接受计算机断层扫描以评估出血情况。我们使用卡方检验和曼-惠特尼检验比较了有和无明显出血事件患者组的实验室数据、ECMO持续时间、住院时间和死亡率。我们还评估了接受止血治疗患者的TAE结果。
43例患者中有24例共发生了25次出血事件。年龄是出血事件和死亡的危险因素。发生出血事件的患者的ECMO平均持续时间和住院时间（分别为42.9天和54.3天）明显长于未发生出血事件的患者（分别为16.2天和25.0天）（p<0.05）。此外，发生出血的患者死亡率（45.8%）高于未出血的患者（15.8%）（p<0.05）。24例患者中有4例的5次事件确认有活动性出血外渗。除1例出血自行停止的病例外，其余4例均尝试并成功实施了TAE。
接受ECMO治疗的老年COVID-19患者发生出血并发症和致命结局的风险更高。TAE对有治疗指征的患者能有效迅速止血。
