背景:体外膜氧合(ECMO)是对COVID-19继发的严重急性呼吸窘迫综合征(ARDS)患者的一种抢救治疗。虽然出血和血栓形成会使ECMO复杂化,这些事件也可能发生在COVID-19之后。关于接受ECMO治疗的COVID-19患者出血和血栓事件的数据很少。
方法:使用COVID-19重症监护联盟数据库,我们对需要ECMO的重度COVID-19成人患者进行了回顾性分析,包括2020年1月至2022年6月的全球中心,以确定与出血和凝血障碍发生相关的ICU死亡风险。
结果:在注册表中接受ECMO支持的1,248例COVID-19患者中,凝血并发症469例(38%),其中252人(54%)经历了出血并发症,165(35%)血栓性并发症,52(11%)。仅有出血性并发症的重症监护病房死亡率的风险比(HR)高于无并发症的患者(校正后的HR=1.60,95%CI1.28-1.99,p<0.001)。1248人中有617人死亡(49.4%),多器官衰竭(617人中有257人死亡[42%])。其次是呼吸衰竭(n=130/617[21%])和感染性休克[n=55/617(8.9%)]。
结论:在接受ECMO治疗的COVID-19ARDS患者中,凝血障碍常见。出血事件对该队列的死亡率有很大贡献。然而,这一风险可能低于以前在单一国家研究或早期病例报告中报告的风险.试用注册ACTRN12620000421932(https://covid19。cochrane.org/studies/crs-13513201).
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is a rescue therapy in patients with severe acute respiratory distress syndrome (ARDS) secondary to COVID-19. While bleeding and thrombosis complicate ECMO, these events may also occur secondary to COVID-19. Data regarding bleeding and thrombotic events in COVID-19 patients on ECMO are sparse.
METHODS: Using the COVID-19 Critical Care Consortium database, we conducted a retrospective analysis on adult patients with severe COVID-19 requiring ECMO, including centers globally from 01/2020 to 06/2022, to determine the risk of ICU mortality associated with the occurrence of bleeding and clotting disorders.
RESULTS: Among 1,248 COVID-19 patients receiving ECMO support in the registry, coagulation complications were reported in 469 cases (38%), among whom 252 (54%) experienced hemorrhagic complications, 165 (35%) thrombotic complications, and 52 (11%) both. The hazard ratio (HR) for Intensive Care Unit mortality was higher in those with hemorrhagic-only complications than those with neither complication (adjusted HR = 1.60, 95% CI 1.28-1.99, p < 0.001). Death was reported in 617 of the 1248 (49.4%) with multiorgan failure (n = 257 of 617 [42%]), followed by respiratory failure (n = 130 of 617 [21%]) and septic shock [n = 55 of 617 (8.9%)] the leading causes.
CONCLUSIONS: Coagulation disorders are frequent in COVID-19 ARDS patients receiving ECMO. Bleeding events contribute substantially to mortality in this cohort. However, this risk may be lower than previously reported in single-nation studies or early case reports. Trial registration ACTRN12620000421932 ( https://covid19.cochrane.org/studies/crs-13513201 ).