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Intracranial Hemorrhages on Extracorporeal Membrane Oxygenation: Differences Between COVID-19 and Other Viral Acute Respiratory Distress Syndrome.
Seeliger, Benjamin; Doebler, Michael; Hofmaenner, Daniel Andrea; Wendel-Garcia, Pedro D; Schuepbach, Reto A; Schmidt, Julius J; Welte, Tobias; Hoeper, Marius M; Gillmann, Hans-Jörg; Kuehn, Christian; Ehrentraut, Stefan Felix; Schewe, Jens-Christian; Putensen, Christian; Stahl, Klaus; Bode, Christian; David, Sascha.
  • Seeliger B; Department of Respiratory Medicine, Medical School Hannover and Member of the German Centre for Lung Research, Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany.
  • Doebler M; Department of Anesthesia and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany.
  • Hofmaenner DA; Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland.
  • Wendel-Garcia PD; Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland.
  • Schuepbach RA; Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland.
  • Schmidt JJ; Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany.
  • Welte T; Department of Respiratory Medicine, Medical School Hannover and Member of the German Centre for Lung Research, Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany.
  • Hoeper MM; Department of Respiratory Medicine, Medical School Hannover and Member of the German Centre for Lung Research, Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany.
  • Gillmann HJ; Department of Anesthesiology, Hannover Medical School, Hannover, Germany.
  • Kuehn C; Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.
  • Ehrentraut SF; Department of Anesthesia and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany.
  • Schewe JC; Department of Anesthesia and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany.
  • Putensen C; Department of Anesthesia and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany.
  • Stahl K; Department of Gastroenterology, Medical School Hannover, Hannover, Germany.
  • Bode C; Department of Anesthesia and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany.
  • David S; Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland.
Crit Care Med ; 50(6): e526-e538, 2022 06 01.
Article in English | MEDLINE | ID: covidwho-1621691
ABSTRACT

OBJECTIVES:

Extracorporeal membrane oxygenation (ECMO) is a potentially lifesaving procedure in acute respiratory distress syndrome (ARDS) due to COVID-19. Previous studies have shown a high prevalence of clinically silent cerebral microbleeds in patients with COVID-19. Based on this fact, together with the hemotrauma and the requirement of therapeutic anticoagulation on ECMO support, we hypothesized an increased risk of intracranial hemorrhages (ICHs). We analyzed ICH occurrence rate, circumstances and clinical outcome in patients that received ECMO support due to COVID-19-induced ARDS in comparison to viral non-COVID-19-induced ARDS intracerebral hemorrhage.

DESIGN:

Multicenter, retrospective analysis between January 2010 and May 2021.

SETTING:

Three tertiary care ECMO centers in Germany and Switzerland. PATIENTS Two-hundred ten ARDS patients on ECMO support (COVID-19, n = 142 vs viral non-COVID, n = 68).

INTERVENTIONS:

None. MEASUREMENTS AND MAIN

RESULTS:

Evaluation of ICH occurrence rate, parameters of coagulation and anticoagulation strategies, inflammation, and ICU survival. COVID-19 and non-COVID-19 ARDS patients showed comparable disease severity regarding Sequential Organ Failure Assessment score, while the oxygenation index before ECMO cannulation was higher in the COVID group (82 vs 65 mm Hg). Overall, ICH of any severity occurred in 29 of 142 COVID-19 patients (20%) versus four of 68 patients in the control ECMO group (6%). Fifteen of those 29 ICH events in the COVID-19 group were classified as major (52%) including nine fatal cases (9/29, 31%). In the control group, there was only one major ICH event (1/4, 25%). The adjusted subhazard ratio for the occurrence of an ICH in the COVID-19 group was 5.82 (97.5% CI, 1.9-17.8; p = 0.002). The overall ICU mortality in the presence of ICH of any severity was 88%.

CONCLUSIONS:

This retrospective multicenter analysis showed a six-fold increased adjusted risk for ICH and a 3.5-fold increased incidence of ICH in COVID-19 patients on ECMO. Prospective studies are needed to confirm this observation and to determine whether the bleeding risk can be reduced by adjusting anticoagulation strategies.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / Extracorporeal Membrane Oxygenation / COVID-19 Type of study: Controlled clinical trial / Etiology study / Observational study / Risk factors Topics: Long Covid Limits: Humans Language: English Journal: Crit Care Med Year: 2022 Document Type: Article Affiliation country: CCM.0000000000005441

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / Extracorporeal Membrane Oxygenation / COVID-19 Type of study: Controlled clinical trial / Etiology study / Observational study / Risk factors Topics: Long Covid Limits: Humans Language: English Journal: Crit Care Med Year: 2022 Document Type: Article Affiliation country: CCM.0000000000005441