To investigate the risk factors of bleeding complications during peripherally inserted extracorporeal membrane oxygenation support in adults
Objective:Exploring the risk factors for bleeding during adult peripheral veno-venous extracorpore-al membrane oxygenation(ECMO)support.Methods:A retrospective analysis was conducted on 50 patients with cardiopulmonary failure requiring ECMO support in the Emergency Intensive Care Unit of Peking University Af-filiated Beijing Luhe Hospital from September 2017 to September 2022.Ten patients who died within 48 hours were excluded,leaving 40 patients included in this study.Patients were divided into two groups based on the pres-ence or absence of bleeding,and general clinical data and coagulation indicators within 24 hours before bleeding were analyzed.Results:Forty patients were included in this study,with 16 cases(40％)in the bleeding group and 24 cases in the non-bleeding group.There were no statistically significant differences between the two groups in terms of age,gender,indications for ECMO,or ECMO type.However,there was a statistically significant difference in pre-ECMO APACHE Ⅱ scores between the two groups(P=0.026),and the ICU mortality was also significantly different(P=0.038).There was a statistically significant difference in pre-fibrinogen(pre-FIB)levels within 24 hours before bleeding(P=0.039).Logistic multivariate regression analysis,after adjusting for confoun-ding factors,identified pre-FIB(P=0.039)as an independent predictor of bleeding,with an OR value of 0.655.The area under the ROC curve for pre-FIB predicting bleeding during ECMO was 0.747(95％CI:0.581-0.914),with the optimal diagnostic threshold at 2.92 ng/mL sensitivity of 87.5％,and specificity of 68.7％.Conclusion:A sustained decrease in fibrinogen levels during adult ECMO support indicates an increased risk of bleeding in patients.
respiratory and circulatory failureextracorporeal membrane oxygenationbleedingfibrinogen
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