Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Gastrointestinal Bleeding in Extracorporeal Membrane Oxygenation Patients: A Comprehensive Analysis of Risk Factors and Clinical Outcomes

  • Sahri Kim (Department of Thoracic and Cardiovascular Surgery, Hallym University Sacred Heart Hospital) ;
  • Jung Hyun Lim (Department of Thoracic and Cardiovascular Surgery, Hallym University Sacred Heart Hospital) ;
  • Ho Hyun Ko (Department of Thoracic and Cardiovascular Surgery, Hallym University Sacred Heart Hospital) ;
  • Lyo Min Kwon (Department of Radiology, Hallym University Sacred Heart Hospital) ;
  • Hong Kyu Lee (Department of Thoracic and Cardiovascular Surgery, Hallym University Sacred Heart Hospital) ;
  • Yong Joon Ra (Department of Thoracic and Cardiovascular Surgery, Hallym University Sacred Heart Hospital) ;
  • Kunil Kim (Department of Thoracic and Cardiovascular Surgery, Hallym University Sacred Heart Hospital) ;
  • Hyoung Soo Kim (Department of Thoracic and Cardiovascular Surgery, Hallym University Sacred Heart Hospital)
  • Received : 2023.09.27
  • Accepted : 2023.12.26
  • Published : 2024.03.05
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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

References

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