Taniguchi Hayato, Abe Takeru, Takeuchi Ichiro, Ohshimo Shinichiro, Shime Nobuaki, Kushimoto Shigeki, Hashimoto Satoru, Takeda Shinhiro
Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Non-profit Organization Japan ECMO Network, Tokyo, Japan.
Thromb Haemost. 2025 Apr;125(4):308-316. doi: 10.1055/a-2411-1000. Epub 2024 Sep 6.
Complications during veno-venous extracorporeal membrane oxygenation (VV-ECMO) are associated with in-hospital mortality. Asian patients on extracorporeal membrane oxygenation (ECMO) have higher risks of bleeding and in-hospital mortality than Caucasian patients. This study aimed to characterize and identify bleeding complications and their associated factors related to in-hospital mortality in patients with severe coronavirus disease 2019 (COVID-19) requiring VV-ECMO in Japan.In this retrospective observational analysis, the prospective nationwide multicenter 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.This study included 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 hemorrhages. 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; = 0.03).Incidence of bleeding complications was 40% in the Japanese population. Gastrointestinal tract bleeding emerged as a significant predictor of adverse outcomes, necessitating further research into preventive strategies and optimized care protocols. These findings can guide the management of VV-ECMO patients with COVID-19.
静脉-静脉体外膜肺氧合（VV-ECMO）期间的并发症与住院死亡率相关。接受体外膜肺氧合（ECMO）的亚洲患者比白种人患者有更高的出血风险和住院死亡率。本研究旨在对日本需要VV-ECMO的重症2019冠状病毒病（COVID-19）患者的出血并发症及其与住院死亡率相关的因素进行特征描述和识别。在这项回顾性观察分析中，使用了前瞻性全国多中心登记系统来追踪COVID-19大流行期间日本各地重症监护病房的实时信息。使用了2020年2月1日至2022年10月31日期间VV-ECMO患者的登记数据。本研究纳入了441例患者；178例（40%）出现以下部位的出血并发症：插管部位20%，胃肠道16%，耳鼻喉16%，气管造口部位13%，胸腔内9%，颅内6%，髂腰肌5%。超过50%的颅内、髂腰肌和胃肠道出血患者停用了抗凝治疗。三分之一的颅内、肌肉内和髂腰肌出血患者停用了ECMO。多变量逻辑回归分析显示，只有胃肠道出血与住院死亡率相关（比值比：2.49；95%置信区间：1.11-5.60；P=0.03）。日本人群中出血并发症的发生率为40%。胃肠道出血是不良结局的重要预测因素，有必要进一步研究预防策略和优化护理方案。这些发现可为COVID-19的VV-ECMO患者的管理提供指导。
