Background

Extracorporeal membrane oxygenation (ECMO) is a rescue therapy in patients with severe acute res‑piratory distress syndrome (ARDS) secondary to COVID‑19. While bleeding and thrombosis complicate ECMO, theseevents may also occur secondary to COVID‑19. Data regarding bleeding and thrombotic events in COVID‑19 patientson ECMO are sparse.

Methods

Using the COVID‑19 Critical Care Consortium database, we conducted a retrospective analysis on adultpatients with severe COVID‑19 requiring ECMO, including centers globally from 01/2020 to 06/2022, to determinethe 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 werereported in 469 cases (38%), among whom 252 (54%) experienced hemorrhagic complications, 165 (35%) throm‑botic complications, and 52 (11%) both. The hazard ratio (HR) for Intensive Care Unit mortality was higher in thosewith 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%]), followedby 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 eventscontribute substantially to mortality in this cohort. However, this risk may be lower than previously reported in single‑nation studies or early case reports.