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von Stillfried, Saskia; Bülow, Roman David; Röhrig, Rainer; Meybohm, Patrick; Boor, Peter; Böcker, Jana; Schmidt, Jens; Tholen, Pauline; Majeed, Raphael; Wienströer, Jan; Weis, Joachim; Bremer, Juliane; Knüchel, Ruth; Breitbach, Anna; Cacchi, Claudio; Freeborn, Benita; Wucherpfennig, Sophie; Spring, Oliver; Braun, Georg; Römmele, Christoph; Märkl, Bruno; Claus, Rainer; Dhillon, Christine; Schaller, Tina; [...]

Intracranial hemorrhage in COVID-19 patients during extracorporeal membrane oxygenation for acute respiratory failure: a nationwide register study report

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  • Media type: E-Article
  • Title: Intracranial hemorrhage in COVID-19 patients during extracorporeal membrane oxygenation for acute respiratory failure: a nationwide register study report
  • Contributor: von Stillfried, Saskia; Bülow, Roman David; Röhrig, Rainer; Meybohm, Patrick; Boor, Peter; Böcker, Jana; Schmidt, Jens; Tholen, Pauline; Majeed, Raphael; Wienströer, Jan; Weis, Joachim; Bremer, Juliane; Knüchel, Ruth; Breitbach, Anna; Cacchi, Claudio; Freeborn, Benita; Wucherpfennig, Sophie; Spring, Oliver; Braun, Georg; Römmele, Christoph; Märkl, Bruno; Claus, Rainer; Dhillon, Christine; Schaller, Tina; [...]
  • imprint: Springer Science and Business Media LLC, 2022
  • Published in: Critical Care
  • Language: English
  • DOI: 10.1186/s13054-022-03945-x
  • ISSN: 1364-8535
  • Origination:
  • Footnote:
  • Description: <jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>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).</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>The electronic registry uses a web-based electronic case report form. In November 2021, the registry included <jats:italic>N</jats:italic> = 1129 confirmed COVID-19 autopsy cases, with data on 63 ECMO autopsy cases and 1066 non-ECMO autopsy cases, contributed from 29 German sites.</jats:p> </jats:sec><jats:sec> <jats:title>Findings</jats:title> <jats:p>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.</jats:p> </jats:sec><jats:sec> <jats:title>Interpretation</jats:title> <jats:p>Our study suggests the potential value of autopsies and a joint interdisciplinary multicenter (national) approach in addressing fatal complications in COVID-19.</jats:p> </jats:sec>
  • Access State: Open Access