Risk Factors for Bleeding and Thrombosis Events on Veno-Arterial Extracorporeal Life Support: An ELSO Analysis

Purpose Our prior work demonstrated Bleeding and thrombosis events (BTEs) are common in adult patients supported with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) but risk factors for these complications are not well understood. Methods We queried the Extracorporeal Life Support Organization (ELSO) Registry for all adults supported with VA-ECMO between Jan/2010 and Dec/2017. We excluded patients receiving E-CPR, multiple ECLS runs, or with diagnoses of coagulopathy or hemorrhage prior to initiating VA-ECMO. Major bleeding was defined as hemorrhage in the brain, lungs, pericardium, or GI tract. The major thrombotic complication was ischemic stroke. Multivariate logistic regression modeling was used to examine pre-ECMO clinical and circuit factors associated with major bleeding and ischemic stroke. Results Of 12,306 patients supported with VA-ECMO, 19.9% had at least one major bleeding event and 3.7 % had ischemic stroke. Relevant patient and circuit characteristics are shown (Table). Central cannulation [adj-OR=2.8, CI 95%= 2.5-3.2] and older age [adj-OR=1.2, CI 95%= 1.1-1.2] were significantly associated with increased rates of major bleeding. A longer duration of ECLS support and lower pH at the time of initiation were associated with higher rates of major bleeding and ischemic stroke (Figure). Conclusion Major bleeding is more common than ischemic stroke in adult patients supported with VA-ECMO. Age, initial pH, central cannulation, and the duration of ECMO support are associated with the risk of these BTEs. Additional studies are needed to refine the risk factors associated with BTEs.