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Major bleeding complications are common and linked to worse outcomes, though specific risk factors in COVID-19 remain unclear.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A retrospective analysis of 151 critically ill patients with COVID-19 on VV-ECMO (March 2020\u2013December 2021) was conducted. The primary outcome was major bleeding (fatal bleeding, haemoglobin drop\u2009\u2265\u200920\u00a0g\/L<jats:sup>\u22121<\/jats:sup> (1.24 mmol\/L<jats:sup>\u22121<\/jats:sup>), or symptomatic bleeding in critical organs). Secondary outcomes included 90-day mortality, kidney replacement therapy, and disease severity.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Major bleeding occurred in 73\/151 patients (48.3%). Only a longer ECMO duration [OR 1.32 (95% CI 1.14\u20131.53; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001)] was identified as an independent risk factor. Kidney replacement therapy independently influenced 90-day mortality [OR 4.48 (95% CI 1.83\u201310.98;<jats:italic>p<\/jats:italic>\u2009=\u20090.001). However, major bleeding, intracranial haemorrhage, higher burden of co-morbidity and mean aPTT before major bleeding were not associated with an increased 90-day mortality risk.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Major bleeding events, including intracranial haemorrhage, are common in patients with COVID-19 being supported by VV-ECMO. However, our data does not demonstrate a direct association between major bleeding and increased 90-day mortality.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12871-025-03380-9","type":"journal-article","created":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T08:17:24Z","timestamp":1759393044000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Outcome of patients with COVID-19 supported by veno-venous extracorporeal membrane oxygenation with major bleeding: a single centre experience"],"prefix":"10.1186","volume":"25","author":[{"given":"Simon","family":"Dubler","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Kowarik","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bettina","family":"Budeus","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomas","family":"Habanik","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Denise","family":"Zwanziger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annabell","family":"Skarabis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Florian","family":"Espeter","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thorsten","family":"Brenner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Herbstreit","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,10,2]]},"reference":[{"key":"3380_CR1","unstructured":"Organization WH. 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Since patient data were gathered retrospectively, patient consent was not necessary.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable due to the retrospective nature of the presented study. The need for consent to participate was waived by an Institutional Review Board (IRB) according to national regulations. The IRB, namely, the ethics committee of the medical faculty of the University of Essen-Duisburg referred to Section \u00a7\u00a06 of the GDNG (Health Data Utilization Act). This states that you may use anonymized patient data without their consent.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Thorsten Brenner - Honoraria for lectures: CSL Behring GmbH, Sch\u00f6chl medical education GmbH, Biotest AG, Baxter Deutschland GmbH, Boehringer Ingelheim Pharma GmbH, Astellas Pharma GmbH, B. Braun Melsungen AG, MSD Sharp & Dohme GmbH, Daiichi Sankyo Deutschland GmbH, Akademie f\u00fcr Infektionsmedizin e.V., L\u00fccke Kongresse GmbH, Pfizer Deutschland GmbH, MVZ Labor Dr. Limbach & Kollegen GbR, Noscendo GmbH. Thorsten Brenner \u2013 Grants: Fraunhofer IGB. Thorsten Brenner - Advisory boards: Baxter Deutschland GmbH, BAYER AG. Thorsten Brenner - Research Funding: Deutsche Forschungsgemeinschaft (DFG), Dietmar Hopp Stiftung, Stiftung Universit\u00e4tsmedizin Essen, Heidelberger Stiftung Chirurgie, Innovationsfonds des Gemeinsamen Bundesausschusses (G-BA). Thorsten Brenner - Leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid: Deutsche Gesellschaft f\u00fcr An\u00e4sthesiologie und Intensivmedizin (DGAI), Deutsche Sepsisgesellschaft (DSG), Deutsche Interdisziplin\u00e4re Vereinigung f\u00fcr Intensiv- & Notfallmedizin (DIVI), Westdeutsches Zentrum f\u00fcr Infektiologie (WZI). Simon Dubler received honoraria for lectures for K\u00f6hler Chemie. Michael Kowarik, Frank Herbstreit, Bettina Budeus, Tomas Habanik, Annabell Skarabis and Florian Espeter declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"477"}}