Intracranial hemorrhage in COVID-19 patients during extracorporeal membrane oxygenation for acute respiratory failure: a nationwide register study report

von Stillfried S, Bülow RD, Röhrig R, Meybohm P, Boor P, Böcker J, Schmidt J, Tholen P, Majeed R, Wienströer J, Weis J, Bremer J, Knüchel R, Breitbach A, Cacchi C, Freeborn B, Wucherpfennig S, Spring O, Braun G, Römmele C, Märkl B, Claus R, Dhillon C, Schaller T, Sipos E, Hirschbühl K, Wittmann M, Kling E, Kröncke T, Heppner FL, Meinhardt J, Radbruch H, Streit S, Horst D, Elezkurtaj S, Quaas A, Göbel H, Hansen T, Titze U, Lorenzen J, Reuter T, Woloszyn J, Baretton G, Hilsenbeck J, Meinhardt M, Pablik J, Sommer L, Holotiuk O, Meinel M, Mahlke N, Esposito I, Crudele G, Seidl M, Amann KU, Coras R, Hartmann A, Eichhorn P, Haller F, Lange F, Schmid KW, Ingenwerth M, Rawitzer J, Theegarten D, Birngruber CG, Wild P, Gradhand E, Smith K, Werner M, Schilling O, Acker T, Gattenlöhner S, Stadelmann C, Metz I, Franz J, Stork L, Thomas C, Zechel S, Ströbel P, Wickenhauser C, Fathke C, Harder A, Ondruschka B, Dietz E, Edler C, Fitzek A, Fröb D, Heinemann A, Heinrich F, Klein A, Kniep I, Lohner L, Möbius D, Püschel K, Schädler J, Schröder AS, Sperhake JP, Aepfelbacher M, Fischer N, Lütgehetmann M, Pfefferle S, Glatzel M, Krasemann S, Matschke J, Jonigk D, Werlein C, Schirmacher P, Domke LM, Hartmann L, Klein IM, Schwab C, Röcken C, Friemann J, Langer D, Roth W, Strobl S, Rudelius M, Stock KF, Weichert W, Delbridge C, Kasajima A, Kuhn PH, Slotta-Huspenina J, Weirich G, Barth P, Wardelmann E, Schnepper A, Evert K, Büttner A, Manhart J, Nigbur S, Bittmann I, Fend F, Bösmüller H, Granai M, Klingel K, Warm V, Steinestel K, Umathum VG, Rosenwald A, Kurz F, Vogt N (2022)

Publication Type: Journal article

Publication year: 2022

Journal

Book Volume: 26

Article Number: 83

Journal Issue: 1

DOI: 10.1186/s13054-022-03945-x

Abstract

Background: In severe cases, SARS-CoV-2 infection leads to acute respiratory distress syndrome (ARDS), often treated by extracorporeal membrane oxygenation (ECMO). During ECMO therapy, anticoagulation is crucial to prevent device-associated thrombosis and device failure, however, it is associated with bleeding complications. In COVID-19, additional pathologies, such as endotheliitis, may further increase the risk of bleeding complications. To assess the frequency of bleeding events, we analyzed data from the German COVID-19 autopsy registry (DeRegCOVID). Methods: The electronic registry uses a web-based electronic case report form. In November 2021, the registry included N = 1129 confirmed COVID-19 autopsy cases, with data on 63 ECMO autopsy cases and 1066 non-ECMO autopsy cases, contributed from 29 German sites. Findings: The registry data showed that ECMO was used in younger male patients and bleeding events occurred much more frequently in ECMO cases compared to non-ECMO cases (56% and 9%, respectively). Similarly, intracranial bleeding (ICB) was documented in 21% of ECMO cases and 3% of non-ECMO cases and was classified as the immediate or underlying cause of death in 78% of ECMO cases and 37% of non-ECMO cases. In ECMO cases, the three most common immediate causes of death were multi-organ failure, ARDS and ICB, and in non-ECMO cases ARDS, multi-organ failure and pulmonary bacterial ± fungal superinfection, ordered by descending frequency. Interpretation: Our study suggests the potential value of autopsies and a joint interdisciplinary multicenter (national) approach in addressing fatal complications in COVID-19.

Authors with CRIS profile

Involved external institutions

Universitätsklinikum Aachen (UKA) Germany (DE) Universität Bielefeld Germany (DE) Klinikum Dortmund Germany (DE) Universitätsklinikum Carl Gustav Carus Dresden Germany (DE) Universitätsklinikum Würzburg Germany (DE) Universitätsklinikum Augsburg Germany (DE) Universitätsklinikum Essen Germany (DE) Universitätsklinikum Frankfurt am Main (KGU) Germany (DE) Universitätsklinikum Freiburg Germany (DE) Universitätsklinikum Gießen und Marburg (UKGM) Germany (DE) Universitätsklinikum Düsseldorf Germany (DE) Georg-August-Universität Göttingen Germany (DE) Charité - Universitätsmedizin Berlin Germany (DE) Universitätsklinikum Köln Germany (DE) Universitätsklinikum Göttingen Germany (DE) Universitätsklinikum Halle (Saale) Germany (DE) Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE) Technische Universität München (TUM) Germany (DE) Universitätsmedizin Rostock Germany (DE) Medizinische Hochschule Hannover (MHH) / Hannover Medical School Germany (DE) Universitätsklinikum Heidelberg Germany (DE) Universitätsklinikum Schleswig-Holstein (UKSH) Germany (DE) Universitätsklinikum Münster Germany (DE) Universitätsklinikum Regensburg Germany (DE) Klinikum Magdeburg Germany (DE) Universitätsmedizin der Johannes Gutenberg-Universität Mainz Germany (DE) Ludwig-Maximilians-Universität (LMU) Germany (DE) Universitätsklinikum Tübingen Germany (DE) Bundeswehrkrankenhaus Ulm Germany (DE) Agaplesion Diakonieklinikum Rotenburg Germany (DE) Julius-Maximilians-Universität Würzburg Germany (DE)

How to cite

APA:

von Stillfried, S., Bülow, R.D., Röhrig, R., Meybohm, P., Boor, P., Böcker, J.,... Vogt, N. (2022). Intracranial hemorrhage in COVID-19 patients during extracorporeal membrane oxygenation for acute respiratory failure: a nationwide register study report. Critical Care, 26(1). https://dx.doi.org/10.1186/s13054-022-03945-x

MLA:

von Stillfried, Saskia, et al. "Intracranial hemorrhage in COVID-19 patients during extracorporeal membrane oxygenation for acute respiratory failure: a nationwide register study report." Critical Care 26.1 (2022).

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