Risk Factors for Bleeding in Coronavirus Disease 2019 Patients on Extracorporeal Membrane Oxygenation and Effects of Transcatheter Arterial Embolization for Hemostasis

Kazuki Goto; Yukihisa Takayama; Gaku Honda; Kazuaki Fujita; Akinobu Osame; Hiroshi Urakawa; Kota Hoshino; Yoshihiko Nakamura; Hiroyasu Ishikura; Kengo Yoshimitsu

doi:10.22575/interventionalradiology.2022-0043

Risk Factors for Bleeding in Coronavirus Disease 2019 Patients on Extracorporeal Membrane Oxygenation and Effects of Transcatheter Arterial Embolization for Hemostasis

Interv Radiol (Higashimatsuyama). 2023 Sep 21;8(3):136-145. doi: 10.22575/interventionalradiology.2022-0043. eCollection 2023 Nov 1.

Authors

Kazuki Goto¹, Yukihisa Takayama¹, Gaku Honda¹, Kazuaki Fujita¹, Akinobu Osame¹, Hiroshi Urakawa¹, Kota Hoshino^{2

3}, Yoshihiko Nakamura^{2

3}, Hiroyasu Ishikura^{2

3}, Kengo Yoshimitsu¹

Affiliations

¹ Department of Radiology, Faculty of Medicine, Fukuoka University, Japan.
² Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, Japan.
³ ECMO Center, Fukuoka University Hospital, Japan.

PMID: 38020462
PMCID: PMC10681754
DOI: 10.22575/interventionalradiology.2022-0043

Abstract

Purpose: To evaluate risk factors for bleeding events in coronavirus disease 2019 (COVID-19) patients on extracorporeal membrane oxygenation (ECMO) and to share the initial results of transcatheter arterial embolization (TAE) for hemostasis.

Material and methods: Forty-three COVID-19 patients who received ECMO from May 2020 to September 2021 were enrolled in this study. Patients with sudden onset anemia immediately underwent computed tomography to assess bleeding. We compared laboratory data, duration of ECMO, hospitalization period, and fatality of patients' groups with and without significant hemorrhagic events using the chi-square test and Mann-Whitney U test. We also assessed the results of TAE in patients who received hemostasis.

Results: A total of 25 bleeding events occurred in 24 of the 43 patients. Age was a risk factor for bleeding events and fatality. The average duration of ECMO and hospitalization period were significantly longer in those with bleeding events (42.9 and 54.3 days) than in those without bleeding events (16.2 and 25.0 days) (p < 0.05). In addition, those with bleeding had higher fatality (45.8%) than those without (15.8%) (p < 0.05). Active extravasation was confirmed for 5 events in 4 of 24 patients. TAE was attempted and performed successfully in all but one of these four cases, in whom bleeding ceased spontaneously.

Conclusions: Elderly COVID-19 patients on ECMO had a greater risk of bleeding complications and fatal outcomes. TAE was effective in providing prompt hemostasis for patients who have the treatment indication.

Keywords: bleeding; coronavirus disease 2019 (COVID-19); extracorporeal membrane oxygenation (ECMO); extravasation; transcatheter arterial embolization (TAE).