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J Chest Surg

Published online February 8, 2024

Copyright © Journal of Chest Surgery.

Gastrointestinal Bleeding in Extracorporeal Membrane Oxygenation Patients: A Comprehensive Analysis of Risk Factors and Clinical Outcomes

Sahri Kim , M.D.1, Jung Hyun Lim , M.D.1, Ho Hyun Ko , M.D.1, Lyo Min Kwon , M.D.2, Hong Kyu Lee , M.D.1, Yong Joon Ra , M.D.1, Kunil Kim , M.D. Ph.D.1, Hyoung Soo Kim , M.D. Ph.D.1

Departments of 1Thoracic and Cardiovascular Surgery and 2Radiology, Hallym University Sacred Heart Hospital, Anyang, Korea

Correspondence to:Hyoung Soo Kim
Tel 82-31-380-3815
Fax 82-31-380-3815
E-mail cskhs99@hallym.or.kr
ORCID
https://orcid.org/0000-0001-6023-0818

Received: September 27, 2023; Revised: December 16, 2023; Accepted: December 26, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) is an intervention for severe heart and lung failure; however, it poses the risk of complications, including gastrointestinal bleeding (GIB). Comprehensive analyses of GIB in patients undergoing ECMO are limited, and its impact on clinical outcomes remains unclear.
Methods: This retrospective study included 484 patients who received venovenous and venoarterial ECMO between January 2015 and December 2022. Data collected included patient characteristics, laboratory results, GIB details, and interventions. Statistical analyses were performed to identify risk factors and assess the outcomes.
Results: GIB occurred in 44 of 484 patients (9.1%) who received ECMO. Multivariable analysis revealed that older age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.01–1.06; p=0.0130) and need to change the ECMO mode (OR, 3.74; 95% CI, 1.75–7.96; p=0.0006) were significant risk factors for GIB, whereas no association was found with antiplatelet or systemic anticoagulation therapies during ECMO management. Half of the patients with GIB (22/44, 50%) underwent intervention, with endoscopy as the primary modality (19/22, 86.4%). Patients who underwent ECMO and developed GIB had higher rates of mortality (40/44 [90.9%] vs. 262/440 [59.5%]) and ECMO weaning failure (38/44 [86.4%] vs. 208/440 [47.3%]).
Conclusion: GIB in patients undergoing ECMO is associated with adverse outcomes, including increased risks of mortality and weaning failure. Even in seemingly uncomplicated cases, it is crucial to avoid underestimating the significance of GIB.

Keywords: Gastrointestinal bleeding, Extracorporeal membrane oxygenation, Complication, Endoscopy, Embolization

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J Chest Surg

Published online February 8, 2024

Copyright © Journal of Chest Surgery.

Gastrointestinal Bleeding in Extracorporeal Membrane Oxygenation Patients: A Comprehensive Analysis of Risk Factors and Clinical Outcomes

Sahri Kim , M.D.1, Jung Hyun Lim , M.D.1, Ho Hyun Ko , M.D.1, Lyo Min Kwon , M.D.2, Hong Kyu Lee , M.D.1, Yong Joon Ra , M.D.1, Kunil Kim , M.D. Ph.D.1, Hyoung Soo Kim , M.D. Ph.D.1

Departments of 1Thoracic and Cardiovascular Surgery and 2Radiology, Hallym University Sacred Heart Hospital, Anyang, Korea

Correspondence to:Hyoung Soo Kim
Tel 82-31-380-3815
Fax 82-31-380-3815
E-mail cskhs99@hallym.or.kr
ORCID
https://orcid.org/0000-0001-6023-0818

Received: September 27, 2023; Revised: December 16, 2023; Accepted: December 26, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) is an intervention for severe heart and lung failure; however, it poses the risk of complications, including gastrointestinal bleeding (GIB). Comprehensive analyses of GIB in patients undergoing ECMO are limited, and its impact on clinical outcomes remains unclear.
Methods: This retrospective study included 484 patients who received venovenous and venoarterial ECMO between January 2015 and December 2022. Data collected included patient characteristics, laboratory results, GIB details, and interventions. Statistical analyses were performed to identify risk factors and assess the outcomes.
Results: GIB occurred in 44 of 484 patients (9.1%) who received ECMO. Multivariable analysis revealed that older age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.01–1.06; p=0.0130) and need to change the ECMO mode (OR, 3.74; 95% CI, 1.75–7.96; p=0.0006) were significant risk factors for GIB, whereas no association was found with antiplatelet or systemic anticoagulation therapies during ECMO management. Half of the patients with GIB (22/44, 50%) underwent intervention, with endoscopy as the primary modality (19/22, 86.4%). Patients who underwent ECMO and developed GIB had higher rates of mortality (40/44 [90.9%] vs. 262/440 [59.5%]) and ECMO weaning failure (38/44 [86.4%] vs. 208/440 [47.3%]).
Conclusion: GIB in patients undergoing ECMO is associated with adverse outcomes, including increased risks of mortality and weaning failure. Even in seemingly uncomplicated cases, it is crucial to avoid underestimating the significance of GIB.

Keywords: Gastrointestinal bleeding, Extracorporeal membrane oxygenation, Complication, Endoscopy, Embolization

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