ID:154 FC-D04-2 Coagulation parameters and vascular events in patients with veno-arterial ECMO

Background: Coagulopathy has been associated with poor outcomes in critically ill patients, but data on the relationship between coagulation parameters and vascular events are very limited in patients receiving veno-arterial (VA) ECMO. Methods: This is a retrospective study performed at a tertiary hospital. Adult patients who received VA-ECMO for cardiogenic shock were enrolled during the eight years. Both peak and minimum levels of various coagulation parameters and vascular events were investigated. Results: Among the patients who received VA-ECMO, 123 patients with cardiogenic shock as the cause of ECMO treatment were included (age, 60.1±13.0 years; female, 37.4%). Their SOFA and SAVE score were 10.8 ± 3.8 and -8.3 ± 6.2, respectively. A total of 21 patients (17.1%) experienced vascular events (limb ischemia, n = 2; ECMO site bleeding, n = 5; Ischemic stroke, n = 7; hermorrhagic stroke, n = 1, GI bleeding, n = 8; two cases had two events). Among various parameters, only peak levels of D-dimer showed significant difference between patients with vascular events and those without (20.0 [16.3 to 20.0] vs. 18.1 [7.6 to 20.0], p = 0.014), and they were well correlated with ECMO duration (r2 = 0.350, P < 0.001). Patients with vascular events had a higher in-hospital mortality compared to those without (18 [85.7%] vs. 50 [49.0%], 0.003). Between survivors and non-survivors, peak and minimum levels of platelets, peak and minimum levels of INR, and minimal levels of antithrombin III were significantly different. Conclusions: In patients who received ECMO for cardiogenic shock, peak levels of D-dimer were not associated with hospital mortality but were associated with vascular events and ECMO duration.