Issue |
J Extra Corpor Technol
Volume 54, Number 3, September 2022
|
|
---|---|---|
Page(s) | 235 - 238 | |
DOI | https://doi.org/10.1051/ject/202254235 | |
Published online | 15 September 2022 |
Case Reports
COVID-19 and Blood Clots: A Report of Massive Pulmonary Embolism in COVID-19 Patient Supported on Veno-Venous ECMO and the Utility of Thrombolysis
* Divisions of Critical Care, Pulmonary and Sleep Medicine, The University of Texas Health Science Center at Houston, Houston, Texas;
† Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Houston, Texas; and
‡ Department of Cardiothoracic Surgery, The University of Kentucky College of Medicine, Lexington, Kentucky
Address correspondence to: Igor D. Gregoric, MD, Program Director, Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, 6400 Fannin, Suite 2350, Houston, TX 77030. E-mail: igor.d.gregoric@uth.tmc.edu
Received:
5
January
2022
Accepted:
23
June
2022
COVID-19 morbidity and mortality are not equivalent to other etiologies of acute respiratory distress syndrome (ARDS) as fulminant activation of coagulation can occur, thereby resulting in widespread microvascular thrombosis and consumption of coagulation factors. A 53-year-old female presented to an emergency center on two occasions with progressive gastrointestinal and respiratory symptoms. She was diagnosed with COVID-19 pneumonia and admitted to a satellite intensive care unit with hypoxemic respiratory failure. She was intubated and mechanically ventilated, but her ARDS progressed over the next 48 hours. The patient was emergently cannulated for veno-venous extracorporeal membrane oxygenation (V-V ECMO) and transferred to our hospital. She was in profound shock requiring multiple vasopressors for hemodynamic support with worsening clinical status on arrival. On bedside echocardiography, she was found to have a massive pulmonary embolism with clot-in-transit visualized in the right atrium and right ventricular outflow tract. After a multidisciplinary discussion, systemic thrombolytic therapy was administered. The patient’s hemodynamics improved and vasopressors were discontinued. This case illustrates the utility of bedside echocardiography in shock determination, the need for continued vigilance in the systematic evaluation of unstable patients in the intensive care unit, and the use of systemic thrombolytics during V-V ECMO in a novel disease process with evolving understanding.
Key words: COVID-19 / pulmonary embolism / ECMO / thrombolysis / blood clot.
© 2022 AMSECT
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