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Indication for ECMO predicts time to first actionable bleeding complication

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Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Purpose

Bleeding is a major complication of patients requiring extracorporeal membrane oxygenation (ECMO). Several risk factors have been identified; however, there remains a paucity of evidence for optimal management of anticoagulation and bleeding in ECMO patients.

Methods

A total of 255 patients required ECMO from January 1996 to December 2021 at a single institution. The Bleeding Academic Research Consortium (BARC) Score was used for defining actionable bleeding. Univariate and multivariate testing were used for outcome analysis. Kaplan-Meier survival curves were plotted for time-to-event analysis.

Results

Of the 255 patients, 147 patients had no actionable bleeding complications, while 108 had at least one actionable bleeding complication. Duration of support (p<0.001) and total number of transfusions (p<0.001) differed between the two groups significantly, with no significant difference in survival to discharge (p=0.894). On multivariate regression, significant predictors for actionable bleeding complications included diabetes (OR 2.01, p=0.03), precannulation hematocrit (OR 0.97, p<0.001), length of support (OR 1.00, p<0.001), use of warfarin (OR 2.28, p=0.03), and post-cardiotomy indication for ECMO (OR 0.77, p=0.02). The median time to first actionable bleeding complication after cannulation was 141.2 h. When stratified by indication for ECMO or type of ECMO circuit, there was a significant difference in time to first actionable bleeding complication (p=0.001, p=0.018).

Conclusions

Indication for ECMO and type of ECMO circuit both are predictive of timing to first actionable bleeding complication in our study. Further data are needed to reliably establish individualized anticoagulation strategies and bleeding management based on indication and circuit setup.

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Funding

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Authors and Affiliations

  1. Division of Cardiac Surgery, London Health Science Centre, London, ON, Canada

    Mohsyn Imran Malik, Djalal Fakim, David Drullinksy & A. Dave Nagpal

  2. Critical Care, London Health Science Centre, London, ON, Canada

    A. Dave Nagpal

  3. Department of Cardiac Surgery, London Health Sciences Centre, University Hospital, 339 Windermere Rd, London, ON, N6A 5A5, Canada

    Mohsyn Imran Malik

Authors
  1. Mohsyn Imran Malik
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  2. Djalal Fakim
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  3. David Drullinksy
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  4. A. Dave Nagpal
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Contributions

MM – conception, writing, editing, figures, tables, data collection, data analysis

DF – writing, editing, tables

DD – editing, supervision

DN – conception, editing, supervision, data collection

Corresponding author

Correspondence to Mohsyn Imran Malik.

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Ethics approval

IRB/ERB Western University HSREB 109252.

Informed consent statement

Implied consent was obtained for all individuals involved in this study at the time of treatment initiation.

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All procedures were in keeping with accordance of the ethical standards of our institutional committee.

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Supplementary Information

ESM 1

ROC Curve for Multivariable Model of ECMO bleeding predictors. Receiver Operating Characteristics (ROC), ECMO: extracorporeal membrane oxygenation (PNG 20 kb)

High Resolution Image (TIFF 163 kb)

ESM 2

Kaplan-Meier Curve for Time to Actionable Bleeding, grouped by ECMO indication, including only patients after 2014. ECMO: extracorporeal membrane oxygenation (PNG 47 kb)

High Resolution Image (TIFF 94 kb)

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Malik, M.I., Fakim, D., Drullinksy, D. et al. Indication for ECMO predicts time to first actionable bleeding complication. Indian J Thorac Cardiovasc Surg 40, 177–183 (2024). https://doi.org/10.1007/s12055-023-01601-9

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  • DOI: https://doi.org/10.1007/s12055-023-01601-9

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