J Extra Corpor Technol 2026, 58, 39 – 42 Ó The Author( s), published by EDP Sciences, 2026 https:// doi. org / 10.1051 / ject / 2025061
Available online at: ject. edpsciences. org
ORIGINAL ARTICLE
Incidence and pathophysiology of gastrointestinal bleeding during mechanical circulatory support: A retrospective analysis using machine learning algorithms
Kelsey Gore( MA, BS, RRT, CES-A) 1,*, Dean Linder Jr( CCP, LP) 1, Juan Jose Martinez Duque( MD) 2, Junxi Wang( BS) 3, Connor Rudnicki( DO) 4, Adrian Alexis Ruiz( MD) 4, Shaun Yockelson( MD) 4, and Bobby Nossaman( MD) 4
1 Department of Cardiovascular Perfusion and Extracorporeal Technology, Ochsner Health, 1514 Jefferson Highway, New Orleans, Louisiana 70121, USA 2 CES University, Cl 10A # 22-04, El Poblado, Medellin, Antioquia, Columbia 3 The University of Queensland Medical School, 288 Herston Road, Herston, QLD 4006, Australia 4 Critical Care Section, Anesthesiology & Perioperative Medicine, Ochsner Health, 1514 Jefferson Highway, New Orleans,
Louisiana 70121, USA Received 7 April 2025, Accepted 12 October 2025
Abstract – Background: End-organ hypoperfusion from cardiopulmonary shock may require mechanical circulatory support( MCS). However, patients receiving MCS risk the development of hemorrhagic complications, including gastrointestinal bleeding( GI). Examining potential risk factors for these complications improves clinical understanding. The purpose of this investigation was to study the risk for GI bleeding in MCS patients. Methods: Following IRB approval, patient characteristics, previously reported comorbidities, and the incidence of GI bleeding were reviewed from January 2017 to October 2023. Clinical variables underwent machine learning with autovalidation. Support vector machine modeling provided the best performance among the ensemble models tested. Results: In this study of 156 patients who underwent 284 MCS procedures, the incidence of GI bleeding was 6.0 % CI 3.3 – 10.4 %. Following machine learning, patients with insulin-dependent diabetes were associated with GI bleeding. The Receiver Operating Characteristic( ROC) curve demonstrated an area under the curve( AUC) of 0.85 with a misclassification rate of 7.5 %. The relative risk of the need for major transfusion(> 2 packed red blood cell units / episode) was 1.7 CI 1.1 – 2.5. The majority( 87 %), but not all, of these patients received unfractionated heparin therapy. Finally, hospital length of stay was increased in patients with GI bleeding. Conclusion: Insulin-dependent diabetes was associated with increased risk for GI bleeding during MCS, and these patients more often required major transfusions. Further evaluation of continuous anticoagulation therapy is warranted. Knowledge derived from this analytical study may guide the development of institutional protocols to improve care in this patient population.
Key words: Gastrointestinal bleeding, Mechanical circulatory support, Transfusion, Hemorrhage, Insulin-dependent diabetes.
Introduction
* Corresponding author: kelsey. gore @ ochsner. org
Cardiopulmonary shock( CS) is characterized by low cardiac output and profound hypotension that can result in endorgan failure [ 1 – 4 ]. Patients refractory to conventional therapies, such as inotropes, vasopressors, and / or mechanical ventilation, may require mechanical circulatory support( MCS) to restore perfusion [ 1 – 5 ]. MCS improves deranged hemodynamics and restores perfusion to the organs. However, MCS is not without complications such as bleeding, thrombosis, and hemolysis [ 4 – 7 ]. The risk of bleeding is exacerbated by the administration of systemic anticoagulation medications commonly given after MCS initiation, such as unfractionated heparin [ 5, 6, 8 ].
Gastrointestinal( GI) bleeding is a recognized complication of MCS [ 5 – 9 ]. Its pathophysiology is multifactorial. Shear stress from MCS disrupts platelet function and impairs von Willebrand factor( vWF), predisposing to acquired von Willebrand syndrome( aVWS) [ 5, 10 ]. Low pulsatility during MCS may also cause mucosal hypoperfusion, ischemia, angiodysplasia, and eventual GI bleeding [ 5, 6, 9, 11 ]. In normal physiology, pulsatile flow regulates nitric oxide( NO) release from endothelial cells. With reduced pulsatility during MCS, impaired NO release can worsen hypotension and GI hypoperfusion [ 5 ].
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