Major Bleeding in Adults Undergoing Peripheral Extracorporeal Membrane Oxygenation (ECMO): Prognosis and Predictors
Background. Major bleeding has been a common and serious complication with poor outcomes in ECMO patients. With a novel, less-invasive cannulation approach and closer coagulation monitoring regime, the incidence of major bleeding is currently not determined yet. Our study aims to examine the inciden...
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| Format: | Article |
| Language: | English |
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Wiley
2022-01-01
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| Series: | Critical Care Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2022/5348835 |
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| author | Tung Phi Nguyen Xuan Thi Phan Tuan Huu Nguyen Dai Quang Huynh Linh Thanh Tran Huy Minh Pham Tu Ngoc Nguyen Hieu Trung Kieu Thao Thi Ngoc Pham |
| author_facet | Tung Phi Nguyen Xuan Thi Phan Tuan Huu Nguyen Dai Quang Huynh Linh Thanh Tran Huy Minh Pham Tu Ngoc Nguyen Hieu Trung Kieu Thao Thi Ngoc Pham |
| author_sort | Tung Phi Nguyen |
| collection | DOAJ |
| description | Background. Major bleeding has been a common and serious complication with poor outcomes in ECMO patients. With a novel, less-invasive cannulation approach and closer coagulation monitoring regime, the incidence of major bleeding is currently not determined yet. Our study aims to examine the incidence of major bleeding, its determinants, and association with mortality in peripheral-ECMO patients. Method. We conducted a single-center retrospective study on adult patients undergoing peripheral-ECMO between January 2019 and January 2020 at a tertiary referral hospital. Determinants of major bleeding were defined by logistic regression analysis. Risk factors of in-hospital mortality were determined by Cox proportional hazard regression analysis. Results. Major bleeding was reported in 33/105 patients (31.4%) and was associated with higher in-hospital mortality [adjusted hazard ratio (aHR) 3.56, 95% confidence interval (CI) 1.63–7.80, p<0.001). There were no significant difference in age, sex, ECMO indications, ECMO modality, pre-ECMO APACHE-II and SOFA scores between two groups with and without major bleeding. Only APTT >72 seconds [adjusted odds ratio (aOR) 7.10, 95% CI 2.60–19.50, p<0.001], fibrinogen <2 g/L [aOR = 7.10, 95% CI 2.60–19.50, p<0.001], and ACT >220 seconds [aOR = 3.9, 95% CI 1.20–11.80, p=0.017] on days with major bleeding were independent predictors. Conclusions. In summary, major bleeding still had a fairly high incidence and poor outcome in peripheral-ECMO patients. APTT > 72 seconds, fibrinogen < 2 g/L were the strongest predicting factors for major bleeding events. |
| format | Article |
| id | doaj-art-750ea1012d0c42938f91b2f0ac2d69d6 |
| institution | Kabale University |
| issn | 2090-1313 |
| language | English |
| publishDate | 2022-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Critical Care Research and Practice |
| spelling | doaj-art-750ea1012d0c42938f91b2f0ac2d69d62025-08-20T03:34:12ZengWileyCritical Care Research and Practice2090-13132022-01-01202210.1155/2022/5348835Major Bleeding in Adults Undergoing Peripheral Extracorporeal Membrane Oxygenation (ECMO): Prognosis and PredictorsTung Phi Nguyen0Xuan Thi Phan1Tuan Huu Nguyen2Dai Quang Huynh3Linh Thanh Tran4Huy Minh Pham5Tu Ngoc Nguyen6Hieu Trung Kieu7Thao Thi Ngoc Pham8Department of Intensive CareDepartment of Intensive CareDepartment of HematologyDepartment of Intensive CareIntensive Care UnitIntensive Care UnitDepartment of Intensive CareDepartment of Intensive CareDepartment of Intensive CareBackground. Major bleeding has been a common and serious complication with poor outcomes in ECMO patients. With a novel, less-invasive cannulation approach and closer coagulation monitoring regime, the incidence of major bleeding is currently not determined yet. Our study aims to examine the incidence of major bleeding, its determinants, and association with mortality in peripheral-ECMO patients. Method. We conducted a single-center retrospective study on adult patients undergoing peripheral-ECMO between January 2019 and January 2020 at a tertiary referral hospital. Determinants of major bleeding were defined by logistic regression analysis. Risk factors of in-hospital mortality were determined by Cox proportional hazard regression analysis. Results. Major bleeding was reported in 33/105 patients (31.4%) and was associated with higher in-hospital mortality [adjusted hazard ratio (aHR) 3.56, 95% confidence interval (CI) 1.63–7.80, p<0.001). There were no significant difference in age, sex, ECMO indications, ECMO modality, pre-ECMO APACHE-II and SOFA scores between two groups with and without major bleeding. Only APTT >72 seconds [adjusted odds ratio (aOR) 7.10, 95% CI 2.60–19.50, p<0.001], fibrinogen <2 g/L [aOR = 7.10, 95% CI 2.60–19.50, p<0.001], and ACT >220 seconds [aOR = 3.9, 95% CI 1.20–11.80, p=0.017] on days with major bleeding were independent predictors. Conclusions. In summary, major bleeding still had a fairly high incidence and poor outcome in peripheral-ECMO patients. APTT > 72 seconds, fibrinogen < 2 g/L were the strongest predicting factors for major bleeding events.http://dx.doi.org/10.1155/2022/5348835 |
| spellingShingle | Tung Phi Nguyen Xuan Thi Phan Tuan Huu Nguyen Dai Quang Huynh Linh Thanh Tran Huy Minh Pham Tu Ngoc Nguyen Hieu Trung Kieu Thao Thi Ngoc Pham Major Bleeding in Adults Undergoing Peripheral Extracorporeal Membrane Oxygenation (ECMO): Prognosis and Predictors Critical Care Research and Practice |
| title | Major Bleeding in Adults Undergoing Peripheral Extracorporeal Membrane Oxygenation (ECMO): Prognosis and Predictors |
| title_full | Major Bleeding in Adults Undergoing Peripheral Extracorporeal Membrane Oxygenation (ECMO): Prognosis and Predictors |
| title_fullStr | Major Bleeding in Adults Undergoing Peripheral Extracorporeal Membrane Oxygenation (ECMO): Prognosis and Predictors |
| title_full_unstemmed | Major Bleeding in Adults Undergoing Peripheral Extracorporeal Membrane Oxygenation (ECMO): Prognosis and Predictors |
| title_short | Major Bleeding in Adults Undergoing Peripheral Extracorporeal Membrane Oxygenation (ECMO): Prognosis and Predictors |
| title_sort | major bleeding in adults undergoing peripheral extracorporeal membrane oxygenation ecmo prognosis and predictors |
| url | http://dx.doi.org/10.1155/2022/5348835 |
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