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

Herrmann J, Schade J, Meybohm P, Paschke N, Hübsch ME, Notz Q, Groene J, Röder D, Kranke P, Merten ML, Landoll M, Spieth P, Kluge S, Jarczak D, Roedl K, Sonntagbauer M, Putensen C, Schewe JC, Ehrentraut SF, Kreyer S, Wehrfritz A, Castellanos I, Bihlmaier K, Schmidt K, Brenner T, Herbstreit F, Espeter F, Wiefhoff J, Ellerkmann RK, Oswald D, Ellger B, Lotz G, Raimann FJ, Wengenmayer T, Staudacher DL, Zotzmann V, Moerer O, Kühn C, Kochanek M, Muellenbach R, Glaser P, Fichtner F, Bodenstein M, Findeisen M, Rembold V, Heim M, Schneider G, Lahmer T, Padberg JS, Hullermann C, Lepper PM, Becker AP, Danziger G, Metz C, Rosenberger P, Mirakaj V, Bernard AM, Braune S, Roth R, Grau A, Heuschmann P, Karagiannidis C, Lotz C (2025)

Publication Type: Journal article

Publication year: 2025

Journal

Book Volume: 12

Article Number: 1649217

DOI: 10.3389/fmed.2025.1649217

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 registration: Registered in the German Clinical Trials Register (study ID: DRKS00022964), retrospectively registered, September 7th 2020, https://drks.de/DRKS00022964.

Authors with CRIS profile

Involved external institutions

Centrum für Integrierte Onkologie Aachen Bonn Köln Düsseldorf (CIO ABCD) Germany (DE) München Klinik gGmbH Germany (DE) Klinikum rechts der Isar Germany (DE) Universitätsmedizin der Johannes Gutenberg-Universität Mainz Germany (DE) Universitätsklinikum Münster Germany (DE) Universitätsklinikum des Saarlandes (UKS) Germany (DE) St. Franziskus-Hospital Münster Germany (DE) Julius-Maximilians-Universität Würzburg Germany (DE) Universitätsklinikum Tübingen Germany (DE) Universität Witten/Herdecke Germany (DE) Universitätsklinikum Würzburg Germany (DE) Universitätsklinikum Carl Gustav Carus Dresden Germany (DE) Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE) Universitätsklinikum Bonn Germany (DE) Universitätsklinikum Essen Germany (DE) Universitätsklinikum Frankfurt am Main (KGU) Germany (DE) Medizinische Hochschule Hannover (MHH) / Hannover Medical School Germany (DE) Universitätsklinikum Göttingen Germany (DE) Universitäts-Herzzentrum Freiburg - Bad Krozingen GmbH Germany (DE) University of Southampton United Kingdom (GB) Asklepios Kliniken Germany (DE) Universität Leipzig Germany (DE) Universitätsklinikum Freiburg Germany (DE)

How to cite

APA:

Herrmann, J., Schade, J., Meybohm, P., Paschke, N., Hübsch, M.E., Notz, Q.,... Lotz, C. (2025). Impact of bleeding and thrombosis on outcome of 945 COVID-19 VV-ECMO cases from a German registry. Frontiers in Medicine, 12. https://doi.org/10.3389/fmed.2025.1649217

MLA:

Herrmann, Johannes, et al. "Impact of bleeding and thrombosis on outcome of 945 COVID-19 VV-ECMO cases from a German registry." Frontiers in Medicine 12 (2025).

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