Acute Vascular Complications of VA-ECMO in COVID-19 Patients. Does COVID-19 Affect the Outcome?

Vascular and endovascular surgery Pub Date : 2025-01-01 Epub Date: 2024-08-28 DOI:10.1177/15385744241276650
Alhussein M Khedr, Mohammed S Foula, Mohammed Alsagheer Alhewy, Abdelaziz Ahmed Abdelhafez, Ibrahim Hanbal Hanbal, Ehab Abd Elmoneim Ghazala, Ahmed Atef Khamis, Hassan Gado, Wael Abdo Abdo Abd-Elgawad, Abdullah El Sayed, Awad Ibrahim, Yasser Elghoneimy, Abdelhalim A Abdelmohsen
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Abstract

Background: Extracorporeal membrane oxygenation (ECMO) through the femoral artery and vein can lead to significant vascular complications. We retrospectively studied the acute vascular complications of Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) in COVID-19 patients compared to non-COVID patients during the period from January 2020 to July 2023.

Results: Seventy-eight patients underwent VA-ECMO for various indications from January 2020 to July 2023. The studied patients had a mean age of 59.6 ± 6.9 years for non-COVID patients (38 patients), and 62.2 ± 7.6 years for COVID patients (40 patients), with a P = 0.268. In non-COVID patients, The baseline characteristics were similar in both groups. The primary indications for ECMO were cardiac diseases, followed by respiratory failure (78.9% vs 10.5%). Conversely, in COVID patients, respiratory failure due to COVID-19 infection was the main indication (45% vs 40%). The overall incidence of general complications, including cerebrovascular stroke, acute kidney injury, intracardiac thrombi, and wound infection, was comparable in both groups (31.6% vs 45%). The overall incidence of vascular complications in both groups was 33.3%. Ipsilateral acute lower limb ischemia occurred in 5.3% vs 10% of non-COVID and COVID patients, respectively. Thrombosis of the distal perfusion catheter (DPC) occurred in 10.5% vs 15%, respectively.

Conclusion: During the COVID-19 pandemic, an increasing number of patients required VA-ECMO due to associated respiratory failure. Patients undergoing VA-ECMO are at high risk of developing various vascular complications. COVID-19 significantly increases the risk of acute limb ischemia and distal perfusion catheter thrombosis in both upper and lower limbs. However, other VA-ECMO-related vascular complications are comparable between COVID-19 and non-COVID patients.

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COVID-19 患者 VA-ECMO 的急性血管并发症。COVID-19 是否会影响疗效?
背景:通过股动脉和静脉进行体外膜氧合(ECMO)可导致严重的血管并发症。我们回顾性研究了 2020 年 1 月至 2023 年 7 月期间 COVID-19 患者与非 COVID 患者进行静脉-动脉体外膜氧合(VA-ECMO)治疗的急性血管并发症:2020年1月至2023年7月期间,78名患者因各种适应症接受了VA-ECMO治疗。非 COVID 患者(38 例)的平均年龄为(59.6 ± 6.9)岁,COVID 患者(40 例)的平均年龄为(62.2 ± 7.6)岁,P = 0.268。在非 COVID 患者中,两组的基线特征相似。ECMO 的主要适应症是心脏病,其次是呼吸衰竭(78.9% 对 10.5%)。相反,在 COVID 患者中,COVID-19 感染导致的呼吸衰竭是主要适应症(45% 对 40%)。两组患者一般并发症的总发生率相当,包括脑血管中风、急性肾损伤、心内血栓和伤口感染(31.6% 对 45%)。两组血管并发症的总发生率均为 33.3%。在非 COVID 和 COVID 患者中,发生同侧急性下肢缺血的比例分别为 5.3% 和 10%。远端灌注导管(DPC)血栓形成的发生率分别为10.5%和15%:结论:在 COVID-19 大流行期间,越来越多的患者因伴有呼吸衰竭而需要 VA-ECMO。接受 VA-ECMO 的患者发生各种血管并发症的风险很高。COVID-19 大大增加了急性肢体缺血和上下肢远端灌注导管血栓形成的风险。不过,COVID-19 和非 COVID 患者发生其他 VA-ECMO 相关血管并发症的风险相当。
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