Acquired Factor XIII Deficiency Is Common during ECMO Therapy and Associated with Major Bleeding Events and Transfusion Requirements

Matthias Noitz; Roxane Brooks; Johannes Szasz; Dennis Jenner; Carl Böck; Niklas Krenner; Martin W Dünser; Jens Meier

doi:10.3390/jcm12124115

Acquired Factor XIII Deficiency Is Common during ECMO Therapy and Associated with Major Bleeding Events and Transfusion Requirements

J Clin Med. 2023 Jun 18;12(12):4115. doi: 10.3390/jcm12124115.

Authors

Matthias Noitz¹, Roxane Brooks¹, Johannes Szasz¹, Dennis Jenner¹, Carl Böck², Niklas Krenner³, Martin W Dünser¹, Jens Meier¹

Affiliations

¹ Department of Anesthesiology and Intensive Care Medicine, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstraße 9, 4020 Linz and Altenberger Strasse 69, 4040 Linz, Austria.
² Institute of Signal Processing, Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria.
³ Department of Cardiac, Vascular and Thoracic Surgery, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstraße 9, 4020 Linz and Altenberger Strasse 69, 4020 Linz, Austria.

Abstract

Background: Bleeding events are frequent complications during extracorporeal membrane oxygenation therapy (ECMO).

Objective: To determine the rate of acquired factor XIII deficiency and its association with major bleeding events and transfusion requirements in adults undergoing ECMO therapy.

Materials and methods: A retrospective single centre cohort study. Adult patients receiving veno-venous or veno-arterial ECMO therapy during a 2-year period were analysed and screened for factor XIII activity measurements. Factor XIII deficiency was defined based on the lowest factor XIII activity measured during ECMO therapy.

Results: Among 84 subjects included into the analysis, factor XIII deficiency occurred in 69% during ECMO therapy. There were more major bleeding events (OR, 3.37; 95% CI, 1.16-10.56; p = 0.02) and higher transfusion requirements (red blood cells, 20 vs. 12, p < 0.001; platelets, 4 vs. 2, p = 0.006) in patients with factor XIII deficiency compared to patients with normal factor XIII activity. In a multivariate regression model, factor XIII deficiency was independently associated with bleeding severity (p = 0.03).

Conclusions: In this retrospective single centre study, acquired factor XIII deficiency was observed in 69% of adult ECMO patients with a high bleeding risk. Factor XIII deficiency was associated with higher rates of major bleeding events and transfusion requirements.

Keywords: ECMO; bleeding; deficiency; factor XIII; red blood cells; transfusion.

Grants and funding

Open Access Funding by the University of Linz.