• Can J Anaesth · Apr 2024

    Definitions of major bleeding for predicting mortality in critically ill adult patients who survived 24 hours while supported with peripheral veno-arterial extracorporeal membrane oxygenation for cardiogenic shock: a comparative historical cohort study.

    • Mouhamed D Moussa, Jérôme Soquet, Emmanuel Robin, Julien Labreuche, Natacha Rousse, Antoine Rauch, Valentin Loobuyck, Guillaume Leroy, Thibault Duburcq, Guillaume Gantois, Xavier Leroy, Slimane Ait-Ouarab, Antoine Lamer, Lise Thellier, Oliver Lukowiak, Guillaume Schurtz, Christophe Muller, Francis Juthier, Sophie Susen, and André Vincentelli.
    • Institut Pasteur de Lille, Université de Lille, Inserm, CHU Lille, Lille, France. mouhamed.moussa@chru-lille.fr.
    • Can J Anaesth. 2024 Apr 1; 71 (4): 523534523-534.

    PurposeThe severity of bleeding events is heterogeneously defined during peripheral veno-arterial extracorporeal membrane oxygenation (pVA-ECMO). We studied three bleeding definitions in pVA-ECMO: the Extracorporeal Life Support Organization (ELSO)-serious bleeding, the Bleeding Academic Research Consortium (BARC), and the universal definition of postoperative bleeding (UPDB) classifications.MethodsWe included consecutive adult patients supported by pVA-ECMO for refractory cardiogenic shock admitted to Lille academic hospitals between January 2013 and December 2019. We assessed the association of bleeding definitions with the primary endpoint of 28-day all-cause mortality with the use of multivariate models accounting for time-dependent and competing variables. We compared models' performances using the Harrell's C-Index and the Akaike information criteria.ResultsTwenty-eight-day mortality occurred in 128/308 (42%) 308 patients. The ELSO-serious bleeding (hazard ratio [HR], 1.67; 95% confidence interval [CI], 1.09 to 2.56) and BARC ≥ type 2 (HR, 1.55; 95% CI, 1.01 to 2.37) were associated with 28-day mortality (Harrell's C-index, 0.69; 95% CI, 0.63 to 0.74 for both). Predictors of ELSO-serious bleeding were postcardiotomy, body mass index, baseline platelets count, fibrinogen, and hemoglobin levels.ConclusionExtracorporeal Life Support Organization-serious bleeding and BARC ≥ type 2 are relevant definitions of major bleeding regarding their association with mortality in critically ill patients who survived the first 24 hr while supported with pVA-ECMO for cardiogenic shock.Study RegistrationCERAR (IRB 00010254-2022-050, Paris, France); first submitted on 18 April 2022.© 2024. Canadian Anesthesiologists' Society.

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