The following is a summary of “Upper gastrointestinal bleeding on veno-arterial extracorporeal membrane oxygenation support,” published in the July 2024 issue of Critical Care by Roux et al.

Patients receiving veno-arterial extracorporeal membrane oxygenation (V-A ECMO) are at increased risk for hemorrhagic complications, particularly upper gastrointestinal bleeding (UGIB).

Researchers conducted a retrospective study assessing the incidence and effects of UGIB in patients with V-A ECMO.

They focused on patients receiving V-A ECMO, excluding patients who died within the first 24 hours (2013–2017). An esophagogastroduodenoscopy (EGD) was performed on all patients suspected of having UGIB. The data was analyzed and compared with the cohort from the start of ECMO until 5 days.

The result showed 150 cases with V-A ECMO, including 65 cases following cardiac surgery and 85 cases due to medical conditions. Prophylactic proton pump inhibitors (PPI) and enteral nutrition were given to 90% of the patients. Among patients suspected of UGIB, 31 underwent EGD, revealing 16 cases were confirmed, resulting in an incidence of 10.7%, with a median onset at 10 (7–17) days. No significant differences were found in clinical or biological factors on the EGD day, patients with UGIB required more packed RBC and fresh frozen plasma, experienced longer MV and ECMO durations, and had extended stays in ICU and the hospital. Mortality rates were similar, with a prior history of peptic ulcer identified as the only independent risk factor for UGIB (OR = 7.32; 95% CI [1.07–50.01], P= 0.042).

Investigators concluded that at least 10% of patients with V-A ECMO experienced UGIB, which significantly affected healthcare resources. Enteral nutrition with PPI prophylaxis did not provide protection, warranting further research on the benefits.

Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01326-x