Clinical correlates for major bleeding during veno-arterial extracorporeal membrane oxygenation support: a time-dependent perspective
Authors' conclusion
A severe major bleeding developed in nearly half of all patients and was associated with an increased mortality risk.
Study context
- Population
- Adults receiving VA ECMO for cardiac failure in 6 Dutch centres, 2016–2023
- Participants
- 558 adults · 6 centres
- Exposure
- Patients with major bleeding vs matched controls who had not bled
- Bleeding casesn = 232
- Outcome
- Major bleeding (surgical or radiological intervention and/or transfusion of > 3 RBC units within 24 h)
Methodological detailsmulticentre, nested matched case-control (up to 4 controls per case), generalized additive models
- Multicentre
- Nested matched case-control (up to 4 controls per case)
- Generalized additive models
Main finding
As reported in the abstract
Major bleeding (≥ 1 event)
Patients with ≥ 1 major bleeding event
232
42%
Total major bleeding episodes
342
Incidence rate per 1000 days at risk
112
Observational data: associations, not effects.
Further findings
ICU mortality
| HR (95% CI) | P value | ||
|---|---|---|---|
| BleedingBleeding associated with higher ICU mortality | 1.39 (1.09–1.76) | P < 0.01 | |
| 0.512Hazard ratio (log scale) |
Timing and site of bleeding
- Early events (< 48 h)
- n = 190, 56%
- Early events at cannulation site
- 37%
- Early events intrathoracic
- 38%
- Later events (> 48 h)
- n = 152, 44%
- Later events intrathoracic
- 53%
Patient factors associated with bleeding
- Female sex and lower body weight associated with bleeding
- P < 0.01
Laboratory markers preceding bleeding, vs controls
- Increased aPTT, prothrombin time, heparin ratio, anti-factor Xa and INR preceding bleeding
- Lower platelet count, hemoglobin and leukocytes preceding bleeding
Original publication
Clinical correlates for major bleeding during veno-arterial extracorporeal membrane oxygenation support: a time-dependent perspective. Crit Care. Published 26 March 2026. doi:10.
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