Intracranial hemorrhage in COVID-19 patients during extracorporeal membrane oxygenation for acute respiratory failure: a nationwide register study report
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Intracranial hemorrhage in COVID-19 patients during extracorporeal membrane oxygenation for acute respiratory failure: a nationwide register study report. / von Stillfried, Saskia; Bülow, Roman David; Röhrig, Rainer; Meybohm, Patrick; Boor, Peter; German Registry of COVID-19 Autopsies (DeRegCOVID), DeRegCOVID Collaborators.
In: CRIT CARE, Vol. 26, No. 1, 83, 28.03.2022.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Intracranial hemorrhage in COVID-19 patients during extracorporeal membrane oxygenation for acute respiratory failure: a nationwide register study report
AU - von Stillfried, Saskia
AU - Bülow, Roman David
AU - Röhrig, Rainer
AU - Meybohm, Patrick
AU - Boor, Peter
AU - German Registry of COVID-19 Autopsies (DeRegCOVID), DeRegCOVID Collaborators
AU - Ondruschka, Benjamin
AU - Dietz, Eric
AU - Edler, Carolin
AU - Fitzek, Antonia Dorothea Elisabeth
AU - Fröb, Daniela
AU - Heinemann, Axel
AU - Heinrich, Fabian
AU - Klein, Anke
AU - Kniep, Inga
AU - Lohner, Larissa
AU - Möbius, Dustin
AU - Püschel, Klaus
AU - Schädler, Julia
AU - Schröder, Ann Sophie
AU - Sperhake, Jan-Peter
AU - Aepfelbacher, Martin
AU - Fischer, Nicole
AU - Lütgehetmann, Marc
AU - Pfefferle, Susanne
AU - Glatzel, Markus
AU - Krasemann, Susanne
AU - Matschke, Jakob
N1 - © 2022. The Author(s).
PY - 2022/3/28
Y1 - 2022/3/28
N2 - BACKGROUND: In severe cases, SARS-CoV-2 infection leads to acute respiratory distress syndrome (ARDS), often treated by extracorporeal membrane oxygenation (ECMO). During ECMO therapy, anticoagulation is crucial to prevent device-associated thrombosis and device failure, however, it is associated with bleeding complications. In COVID-19, additional pathologies, such as endotheliitis, may further increase the risk of bleeding complications. To assess the frequency of bleeding events, we analyzed data from the German COVID-19 autopsy registry (DeRegCOVID).METHODS: The electronic registry uses a web-based electronic case report form. In November 2021, the registry included N = 1129 confirmed COVID-19 autopsy cases, with data on 63 ECMO autopsy cases and 1066 non-ECMO autopsy cases, contributed from 29 German sites.FINDINGS: The registry data showed that ECMO was used in younger male patients and bleeding events occurred much more frequently in ECMO cases compared to non-ECMO cases (56% and 9%, respectively). Similarly, intracranial bleeding (ICB) was documented in 21% of ECMO cases and 3% of non-ECMO cases and was classified as the immediate or underlying cause of death in 78% of ECMO cases and 37% of non-ECMO cases. In ECMO cases, the three most common immediate causes of death were multi-organ failure, ARDS and ICB, and in non-ECMO cases ARDS, multi-organ failure and pulmonary bacterial ± fungal superinfection, ordered by descending frequency.INTERPRETATION: Our study suggests the potential value of autopsies and a joint interdisciplinary multicenter (national) approach in addressing fatal complications in COVID-19.
AB - BACKGROUND: In severe cases, SARS-CoV-2 infection leads to acute respiratory distress syndrome (ARDS), often treated by extracorporeal membrane oxygenation (ECMO). During ECMO therapy, anticoagulation is crucial to prevent device-associated thrombosis and device failure, however, it is associated with bleeding complications. In COVID-19, additional pathologies, such as endotheliitis, may further increase the risk of bleeding complications. To assess the frequency of bleeding events, we analyzed data from the German COVID-19 autopsy registry (DeRegCOVID).METHODS: The electronic registry uses a web-based electronic case report form. In November 2021, the registry included N = 1129 confirmed COVID-19 autopsy cases, with data on 63 ECMO autopsy cases and 1066 non-ECMO autopsy cases, contributed from 29 German sites.FINDINGS: The registry data showed that ECMO was used in younger male patients and bleeding events occurred much more frequently in ECMO cases compared to non-ECMO cases (56% and 9%, respectively). Similarly, intracranial bleeding (ICB) was documented in 21% of ECMO cases and 3% of non-ECMO cases and was classified as the immediate or underlying cause of death in 78% of ECMO cases and 37% of non-ECMO cases. In ECMO cases, the three most common immediate causes of death were multi-organ failure, ARDS and ICB, and in non-ECMO cases ARDS, multi-organ failure and pulmonary bacterial ± fungal superinfection, ordered by descending frequency.INTERPRETATION: Our study suggests the potential value of autopsies and a joint interdisciplinary multicenter (national) approach in addressing fatal complications in COVID-19.
KW - COVID-19/complications
KW - Extracorporeal Membrane Oxygenation/adverse effects
KW - Humans
KW - Intracranial Hemorrhages/complications
KW - Male
KW - Respiratory Distress Syndrome/therapy
KW - Respiratory Insufficiency/etiology
KW - SARS-CoV-2
U2 - 10.1186/s13054-022-03945-x
DO - 10.1186/s13054-022-03945-x
M3 - SCORING: Journal article
C2 - 35346314
VL - 26
JO - CRIT CARE
JF - CRIT CARE
SN - 1364-8535
IS - 1
M1 - 83
ER -
