Abstract
Background: The use of extracorporeal membrane oxygenation (ECMO) to
support critically ill patients with cardiorespiratory dysfunction is
increasing over the last decades. However, hemorrhagic complications
remain occurring frequently during ECMO support, which have a
significant impact on morbidity and mortality. Methods: A retrospective
study was performed on the 60 patients, who were admitted to the Taihe
hospital in Shiyan City, Hubei Province from February 2017 to October
2020. All those were rescued with ECMO. Including 18 patients developed
hemorrhage complications and 42 patients did not. Demographic,
laboratory tests, clinical manifestations prior to ECMO were collected
to analysis the clinical features. Univariable and multivariable
logistic analysis methods were used in our study to explore the risk
factors for hemorrhage in adults on ECMO. Results: There were
significant differences between the hemorrhage group and no-hemorrhage
group in duration of ECMO support, mode of ECMO, red blood cell count,
hemoglobin, platelet count, serum creatinine. Particularly, multivariate
logistic analysis showed that the longer duration of ECMO support and
the higher activated partial thromboplastin time (APTT) prior to ECMO
were independent factors for hemorrhage in adults on ECMO. In addition,
we found that the mortality of hemorrhagic patients was higher than
no-hemorrhagic patients. Cannula site was the most common bleeding site.
Most bleeding events occurred within the first three days of ECMO
therapy. Conclusions: Clinicians should evaluate the risk of hemorrhage
based on patients’ coagulation function, underlying disease as well as
the duration of ECMO support. Especially in the first three days during
ECMO support. Attempting to wean from ECMO early whenever feasible is
also effective to reduce the occurrence of hemorrhage. Special attention
should be given on cannula site, mucosal, dermal and digestive tract to
alert hemorrhage.