The Role of Excessive Anticoagulation and Missing Hyperinflammation in ECMO-Associated Bleeding
Extracorporeal membrane oxygenation (ECMO) is increasingly used in carefully selected patients with cardiac or respiratory failure. However, complications are common and can be associated with worse outcomes, while data on risk factors and outcomes are inconsistent and sparse. Therefore, we sought t...
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| Format: | Article |
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MDPI AG
2022-04-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/9/2314 |
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| author | Sasa Rajsic Robert Breitkopf Ulvi Cenk Oezpeker Zoran Bukumirić Moritz Dobesberger Benedikt Treml |
| author_facet | Sasa Rajsic Robert Breitkopf Ulvi Cenk Oezpeker Zoran Bukumirić Moritz Dobesberger Benedikt Treml |
| author_sort | Sasa Rajsic |
| collection | DOAJ |
| description | Extracorporeal membrane oxygenation (ECMO) is increasingly used in carefully selected patients with cardiac or respiratory failure. However, complications are common and can be associated with worse outcomes, while data on risk factors and outcomes are inconsistent and sparse. Therefore, we sought to investigate potential risk factors and predictors of haemorrhage and adverse events during ECMO and its influence on mortality. We retrospectively reviewed all patients on ECMO support admitted to intensive care units of a tertiary university centre in Austria. In a period of ten years, ECMO support was used in 613 patients, with 321 patients meeting the inclusion criteria of this study. Haemorrhage, occurring in more than one third of the included patients (123, 38%), represented the most common and serious ECMO complication, being associated with an increased one year mortality (51% vs. 35%, <i>p</i> = 0.005). The main risk factors for haemorrhage were severity of the disease (hazard ratio (HR) = 1.01, <i>p</i> = 0.047), a prolonged activated partial thromboplastin time (HR = 1.01, <i>p</i> = 0.007), and lower values of C-reactive protein (HR = 0.96, <i>p</i> = 0.005) and procalcitonin (HR = 0.99, <i>p</i> = 0.029). In summary, haemorrhage remained the main ECMO complication with increased mortality. Moreover, we reported a possible association of lower inflammation and bleeding during ECMO support for the first time. This generated a new hypothesis that warrants further research. Finally, we recommend stricter monitoring of anticoagulation especially in patients without hyperinflammation. |
| first_indexed | 2024-03-10T04:02:07Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T04:02:07Z |
| publishDate | 2022-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-246732a8381a49529b64724c3cfb328e2023-11-23T08:30:33ZengMDPI AGJournal of Clinical Medicine2077-03832022-04-01119231410.3390/jcm11092314The Role of Excessive Anticoagulation and Missing Hyperinflammation in ECMO-Associated BleedingSasa Rajsic0Robert Breitkopf1Ulvi Cenk Oezpeker2Zoran Bukumirić3Moritz Dobesberger4Benedikt Treml5General and Surgical Intensive Care Unit, Department of Anaesthesiology and Critical Care Medicine, Medical University Innsbruck, 6020 Innsbruck, AustriaTransplant Surgical Intensive Care Unit, Department of Anaesthesiology and Critical Care Medicine, Medical University Innsbruck, 6020 Innsbruck, AustriaDepartment of Cardiac Surgery, Medical University Innsbruck, 6020 Innsbruck, AustriaInstitute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, SerbiaGeneral and Surgical Intensive Care Unit, Department of Anaesthesiology and Critical Care Medicine, Medical University Innsbruck, 6020 Innsbruck, AustriaGeneral and Surgical Intensive Care Unit, Department of Anaesthesiology and Critical Care Medicine, Medical University Innsbruck, 6020 Innsbruck, AustriaExtracorporeal membrane oxygenation (ECMO) is increasingly used in carefully selected patients with cardiac or respiratory failure. However, complications are common and can be associated with worse outcomes, while data on risk factors and outcomes are inconsistent and sparse. Therefore, we sought to investigate potential risk factors and predictors of haemorrhage and adverse events during ECMO and its influence on mortality. We retrospectively reviewed all patients on ECMO support admitted to intensive care units of a tertiary university centre in Austria. In a period of ten years, ECMO support was used in 613 patients, with 321 patients meeting the inclusion criteria of this study. Haemorrhage, occurring in more than one third of the included patients (123, 38%), represented the most common and serious ECMO complication, being associated with an increased one year mortality (51% vs. 35%, <i>p</i> = 0.005). The main risk factors for haemorrhage were severity of the disease (hazard ratio (HR) = 1.01, <i>p</i> = 0.047), a prolonged activated partial thromboplastin time (HR = 1.01, <i>p</i> = 0.007), and lower values of C-reactive protein (HR = 0.96, <i>p</i> = 0.005) and procalcitonin (HR = 0.99, <i>p</i> = 0.029). In summary, haemorrhage remained the main ECMO complication with increased mortality. Moreover, we reported a possible association of lower inflammation and bleeding during ECMO support for the first time. This generated a new hypothesis that warrants further research. Finally, we recommend stricter monitoring of anticoagulation especially in patients without hyperinflammation.https://www.mdpi.com/2077-0383/11/9/2314anticoagulationaPTTbleedingcomplicationsextracorporeal life supportECMO |
| spellingShingle | Sasa Rajsic Robert Breitkopf Ulvi Cenk Oezpeker Zoran Bukumirić Moritz Dobesberger Benedikt Treml The Role of Excessive Anticoagulation and Missing Hyperinflammation in ECMO-Associated Bleeding Journal of Clinical Medicine anticoagulation aPTT bleeding complications extracorporeal life support ECMO |
| title | The Role of Excessive Anticoagulation and Missing Hyperinflammation in ECMO-Associated Bleeding |
| title_full | The Role of Excessive Anticoagulation and Missing Hyperinflammation in ECMO-Associated Bleeding |
| title_fullStr | The Role of Excessive Anticoagulation and Missing Hyperinflammation in ECMO-Associated Bleeding |
| title_full_unstemmed | The Role of Excessive Anticoagulation and Missing Hyperinflammation in ECMO-Associated Bleeding |
| title_short | The Role of Excessive Anticoagulation and Missing Hyperinflammation in ECMO-Associated Bleeding |
| title_sort | role of excessive anticoagulation and missing hyperinflammation in ecmo associated bleeding |
| topic | anticoagulation aPTT bleeding complications extracorporeal life support ECMO |
| url | https://www.mdpi.com/2077-0383/11/9/2314 |
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