Supervisors info:
Θεόδωρος Κατσούλας, Καθηγητής, Τμήμα Νοσηλευτικής, ΕΚΠΑ
Πέτρος Γαλάνης, Επίκουρος Καθηγητής, Τμήμα Νοσηλευτικής, ΕΚΠΑ
Παντελής Στεργιάννης, Επίκουρος Καθηγητής, Τμήμα Νοσηλευτικής, ΕΚΠΑ
Summary:
Introduction: During the last years, due to the pandemic of Covid – 19 more and more patients were in need to receive ECMO therapy. Because of this reason, ECMO became popular for scientists to investigate further its parameters, such us indications, complications and risk factors of that specific system.
Purpose: The purpose of this systematic review is to investigate the risk factors that are responsible for bleeding events during ECMO therapy.
Material and Method: The review was conducted following research on the electronic databases PubMed, Google Scholar, and Medline. The keywords used were "bleeding," "risk factors," "ECLS," and "ECMO." From the search, 10 studies were identified between the years 2015 and 2023, along with one study from 1999. These studies fell into the following categories: patient testimonies, observational studies, cohort studies, prospective studies, and retrospective studies. All participants were above 17 years old, and all studies were conducted in Intensive Care Units or specialized ECMO treatment centers. The results of the research emerged after a statistical analysis of the studied variables using appropriate logistic methods.
Results: The most frequently encountered risk factors contributing to the occurrence of hemorrhagic events were found to be low platelet levels, low fibrinogen levels, prolonged activated partial thromboplastin time (aPTT), and prolonged extracorporeal membrane oxygenation (ECMO) duration. Additionally, although less common, factors with significant statistical importance included aggressive anticoagulation therapy, high international normalized ratio (INR) and activated clotting time (ACT), deficiency of factors XIII, X, and V, elevated bilirubin and creatinine, prolonged ICU stay, diabetes mellitus, fungal pneumonia, increased pH, acute renal failure, female gender, persistent hypoxemia for > 24 hours, and acquired von Willebrand syndrome.
The manifestations of bleeding complications vary, and depending on their anatomical location, they can influence patient outcomes. The most common sites affected are the gastrointestinal tract, catheter insertion points, surgical traumas, intracranial bleeding, hematuria, skin, and the oro/nasopharyngeal space.
Conclusions: Ηemorrhage occurrence represents one of the most frequent and serious complications during ECMO therapy, with high mortality rates. For this reason, further investigation of the phenomenon is essential to identify better prevention and management strategies, thereby making the treatment even more effective.
