Coagulation parameters in patients with COVID-19 and non-COVID-19 viral pneumonia requiring veno-venous extracorporeal membrane oxygenation

Objective: Hemorrhage and thrombotic events are common issues during extracorporeal membrane oxygenation (ECMO). Furthermore, severe COVID-19 infection is frequently associated with coagulopathy, leading to lung embolism and influencing ECMO oxygenator functionality. Therefore, providing ECMO therapy in those patients might be challenging. We aimed to identify differences in coagulation parameters between patients with COVID-19 and non- COVID-19 viral pneumonia on venovenous (VV) ECMO. Methods: A retrospective single-center study on patients supported with VV ECMO for acute respiratory failure associated with COVID-19 or non-COVID-19 viral pneumonia was performed. Coagulation parameters at different time points were analyzed. Results: Between January 2018 and December 2020, 68 patients, including 31 with COVID-19 pneumonia and 37 with non-COVID-19 viral pneumonia, were eligible for the analysis. Activated partial thromboplastin time (aPTT) on day one and international normalized ratio (INR) on day one and five were significantly lower in the COVID-19 group. At all respective time points, COVID-19 patients showed higher levels of platelets and fibrinogen. In contrast, non-COVID-19 patients had greater d-dimer levels on day five. Additionally, significant differences in factor VIII and XIII activity levels were observed (Figure 1). ECMO weaning rate did not differ significantly between the groups. Conclusions: Coagulation parameters before and during the first days of ECMO for acute respiratory failure differed significantly between patients with COVID-19 and non-COVID-19 viral pneumonia. Monitoring coagulation parameters in order to prevent hemostatic complications will play a crucial role in COVID-19 patients and especially anticoagulation management will be of particular importance and should therefore be further investigated in future studies.