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Predictors of thrombosis during VV ECMO: an analysis of 9809 patients from the ELSO registry

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Abstract

Venovenous extracorporeal membrane oxygenation (VV-ECMO) is a life-saving therapy for critically ill patients, but it carries an increased risk of thrombosis due to blood interacting with non-physiological surfaces. While the relationship between clinical variables and thrombosis remains unclear, our study aimed to identify which factors are most predictive of thrombosis. The Extracorporeal Life Support Organization Registry was queried to obtain a cohort of VV-ECMO patients aged 18 years and older from 2015 to 2019. Patients who were over 80-years-old, at the extremes of weight, who received less than 24 h of ECMO, multiple rounds of ECMO, or had missing data were excluded. Multivariate logistic regression modeling was used to assess predictors of thrombosis and mortality. A total of 9809 patients were included in the analysis, with a mean age of 47.1 ± 15.1 years and an average ECMO run time of 305 ± 353 h. Thrombosis occurred in 19.9% of the cohort, with circuit thrombosis (8.6%) and membrane lung failure (6.1%) being the most common. Multivariate analysis showed that ECMO runs over 14 days (OR: 2.62, P < 0.001) and pregnancy-related complications (OR: 1.79, P = 0.004) were associated with an increased risk of thrombosis. Risk factors for circuit thrombosis included incremental unit increases in the pump flow rate at 24 h (OR: 1.07 [1.00–1.14], P = 0.044) and specific cannulation sites. Increased body weight (OR: 1.02 [1.00–1.04], P = 0.026) and increased duration on ECMO (OR: 3.82 [3.12–4.71], P < 0.001) were predictive of membrane lung failure. Additionally, patients with thrombosis were at increased likelihood of in-hospital mortality (OR: 1.52, P < 0.001). This study identified multiple thrombotic risk factors in VV-ECMO, suggesting that future studies investigating the impact of pregnancy associated complications and ECMO flow rate on hemostasis would be illuminating.

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Funding

This work has been supported by grants from the National Institutes of Health (R01HL101972, R01HL151367).

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Authors and Affiliations

  1. Department of Biomedical Engineering, Oregon Health & Science University, 3303 S. Bond Avenue, Portland, OR, 97239, USA

    Tia C. L. Kohs, Owen J. T. McCarty & Joseph J. Shatzel

  2. Program in Molecular and Cellular Biology, Oregon Health & Science University, Portland, OR, USA

    Benjamin R. Weeder

  3. Department of Internal Medicine, Oregon Health & Science University, Portland, OR, USA

    Boris I. Chobrutskiy & Thomas Kartika

  4. Department of Pharmacy, Oregon Health & Science University, Portland, OR, USA

    Kerry K. Moore

  5. Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, Oregon Health & Science University, Portland, OR, USA

    David Zonies

  6. Department of Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland, OR, USA

    Bishoy Zakhary

  7. Division of Hematology and Oncology, Oregon Health & Science University, Portland, OR, USA

    Joseph J. Shatzel

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  1. Tia C. L. Kohs
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Correspondence to Tia C. L. Kohs.

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J.J. Shatzel reports receiving consulting fees from Aronora, Inc. The Oregon Health & Science University Conflict of Interest in Research Committee has reviewed and managed this potential conflict of interest. The remaining authors declare no potential conflict of interest.

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Kohs, T.C.L., Weeder, B.R., Chobrutskiy, B.I. et al. Predictors of thrombosis during VV ECMO: an analysis of 9809 patients from the ELSO registry. J Thromb Thrombolysis 57, 345–351 (2024). https://doi.org/10.1007/s11239-023-02909-4

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