Thombosis, major bleeding, and survival in COVID-19 supported by veno-venous extracorporeal membrane oxygenation in the first vs second wave: a multicenter observational study in the United Kingdom

• Published in: Journal of thrombosis and haemostasis 2023-10, Vol.21 (10), p.2735-2746
• Main Authors: Arachchillage, Deepa J., Weatherill, Anna, Rajakaruna, Indika, Gaspar, Mihaela, Odho, Zain, Isgro, Graziella, Cagova, Lenka, Fleming, Lucy, Ledot, Stephane, Laffan, Mike, Szydlo, Richard, Jooste, Rachel, Scott, Ian, Vuylsteke, Alain, Yusuff, Hakeem
• Format: Article
• Language: English
• Subjects: COVID-19; extracorporeal membrane oxygenation; hemorrhage; mortality; thrombosis
• ISSN: 1538-7836; 1538-7836
• DOI: 10.1016/j.jtha.2023.06.034

Bleeding and thrombosis are major complications of veno-venous (VV) extracorporeal membrane oxygenation (ECMO). To assess thrombosis, major bleeding (MB), and 180-day survival in patients supported by VV-ECMO between the first (March 1 to May 31, 2020) and second (June 1, 2020, to June 30, 2021) waves of the COVID-19 pandemic. An observational study of 309 consecutive patients (aged ≥18years) with severe COVID-19 supported by VV-ECMO was performed in 4 nationally commissioned ECMO centers in the United Kingdom. Median age was 48 (19-75) years, and 70.6% were male. Probabilities of survival, thrombosis, and MB at 180 days in the overall cohort were 62.5% (193/309), 39.8% (123/309), and 30% (93/309), respectively. In multivariate analysis, an age of >55 years (hazard ratio [HR], 2.29; 95% CI, 1.33-3.93; P = .003) and an elevated creatinine level (HR, 1.91; 95% CI, 1.19-3.08; P = .008) were associated with increased mortality. Correction for duration of VV-ECMO support, arterial thrombosis alone (HR, 3.0; 95% CI, 1.5-5.9; P = .002) or circuit thrombosis alone (HR, 3.9; 95% CI, 2.4-6.3; P < .001) but not venous thrombosis increased mortality. MB during ECMO had a 3-fold risk (95% CI, 2.6-5.8, P < .001) of mortality. The first wave cohort had more males (76.7% vs 64%; P = .014), higher 180-day survival (71.1% vs 53.3%; P = .003), more venous thrombosis alone (46.4% vs 29.2%; P = .02), and lower circuit thrombosis (9.2% vs 28.1%; P < .001). The second wave cohort received more steroids (121/150 [80.6%] vs 86/159 [54.1%]; P < .0001) and tocilizumab (20/150 [13.3%] vs 4/159 [2.5%]; P = .005). MB and thrombosis are frequent complications in patients on VV-ECMO and significantly increase mortality. Arterial thrombosis alone or circuit thrombosis alone increased mortality, while venous thrombosis alone had no effect. MB during ECMO support increased mortality by 3.9-fold. •Veno-venous extracorporeal membrane oxygenation can be lifesaving in patients with severe COVID-19.•Outcomes of veno-venous extracorporeal membrane oxygenation–supported patients were compared between the first and second waves of the COVID-19 pandemic.•The second wave had higher mortality, circuit thrombosis, and major bleeding but lower venous thrombosis.•Major bleeding and arterial and circuit thrombosis were associated with increased mortality.