AUTHOR=Herrmann Johannes , Schade Janno , Meybohm Patrick , Paschke Noah , Hübsch Martha E. , Notz Quirin , Groene Julie , Röder Daniel , Kranke Peter , Merten Michaela L. , Landoll Micha , Spieth Peter , Kluge Stefan , Jarczak Dominik , Roedl Kevin , Sonntagbauer Michael , Putensen Christian , Schewe Jens-Christian , Ehrentraut Stefan F. , Kreyer Stefan , Wehrfritz Andreas , Castellanos Ixchel , Bihlmaier Karl , Schmidt Karsten , Brenner Thorsten , Herbstreit Frank , Espeter Florian , Wiefhoff Jan , Ellerkmann Richard K. , Oswald Daniel , Ellger Björn , Lotz Gösta , Raimann Florian J. , Wengenmayer Tobias , Staudacher Dawid L. , Zotzmann Viviane , Moerer Onnen , Kühn Christian , Kochanek Matthias , Muellenbach Ralf , Glaser Patricia , Fichtner Falk , Bodenstein Marc , Findeisen Michael , Rembold Vanessa , Heim Markus , Schneider Gerhard , Lahmer Tobias , Padberg Jan-Sören , Hullermann Carsten , Lepper Philipp M. , Becker Andre P. , Danziger Guy , Metz Carlos , Rosenberger Peter , Mirakaj Valbona , Bernard Alice-Marie , Braune Stephan , Roth Rebecca , Grau Anna , Heuschmann Peter , Karagiannidis Christian , Lotz Christopher 

TITLE=Impact of bleeding and thrombosis on outcome of 945 COVID-19 VV-ECMO cases from a German registry

JOURNAL=Frontiers in Medicine

VOLUME=Volume 12 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2025.1649217

DOI=10.3389/fmed.2025.1649217

ISSN=2296-858X

ABSTRACT=Bleeding and thromboembolic events (BTE) increase the mortality of COVID-19 acute respiratory distress syndrome (ARDS) treated with extracorporeal membrane oxygenation (ECMO). The current analysis aimed to assess frequency and determinants of BTE according to their location and severity in a retrospective analysis of the German ECMO COVID-19 registry. Logistic regression was applied to identify factors influencing ICU survival as well as variables associated with risks of BTE. In total, 708 of 945 patients (75%) suffered from BTE. Overall, 1,348 events were registered, including 406 (30%) major bleeding and 258 (19%) major thromboembolic events. Most common major bleeding locations were intracranial (n = 133, 10%) and pulmonary bleeding (n = 116, 9%). In-ICU survival was 35, 46% without BTE and 22% with major bleeding (p < 0.05). In summary, major bleeding was a core outcome-determinant of COVID-19 ECMO mortality with intracranial major bleeding as the most devastating complication (OR: 5.3; CI: 2.9–9.9; p < 0.001). Neither major thromboembolism nor minor BTE impacted ICU-mortality. Potentially modifiable factors associated with major bleeding included prolonged duration of ECMO >14 days (OR: 2.9; CI 1.8–4.7; p < 0.001) and platelet counts <100.000/μL ≥ 72 h (OR: 2.0; CI 1.1–3.6; p = 0.018). Hence, prevention, early recognition and treatment of major bleedings are key to increase the survival of COVID-19 ECMO. In this regard, our data indicate that the implementation of early weaning strategies to minimize duration of ECMO therapy and prevention of prolonged thrombocytopenia with platelet counts <100.000/μl ≥ 72 h could decrease the risk of devastating bleeds and could ameliorate survival.Clinical trial registrationRegistered in the German Clinical Trials Register (study ID: DRKS00022964), retrospectively registered, September 7th 2020, https://drks.de/DRKS00022964.