Risk factors for bleeding and thrombotic complications during extracorporeal membrane oxygenation support in adults based on the MIMIC-IV database.

Objective: To identify risk factors for bleeding and thrombotic complications during extracorporeal membrane oxygenation (ECMO) support in adults and to develop a predictive model based on these factors.

Method: Data from 323 adult patients treated with ECMO in the Medical Information Mart for Intensive Care IV (MIMIC-IV) database were retrospectively analyzed. Demographic information, clinical characteristics, and laboratory test results were collected. Kaplan-Meier (K-M) and Cox regression analyses were used to identify risk factors for bleeding and thrombotic complications and construct a predictive model.

Results: Bleeding and thrombotic complications was noted in 84 (26.0%) patients, with a median onset time of 13 days after ECMO. Univariate analysis identified age, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, ECMO indication, ECMO withdrawal, extracorporeal cardiopulmonary resuscitation (ECPR), and coagulation function as potential risk factors (all P < 0.05). Multivariate analysis revealed that ECMO withdrawal and platelet count (PLT) were independent protective factors, while D-dimer was an independent risk factor (P < 0.05). A predictive model was developed based on ECMO withdrawal, D-dimer, and PLT, with areas under the curves (AUCs) of 0.932, 0.931, and 0.941 for predicting bleeding complications at 6, 9, and 12 days after ECMO treatment, respectively.

Conclusion: The incidence of ECMO-related bleeding and thrombotic complications is high. ECMO withdrawal, PLT, and D-dimer are independent influencing factors. This predictive model can assist in early identification of high-risk patients and guide clinical decision-making.