Ventilatory Failure And Pulmonary Embolism In Covid-19 Requiring Enhanced Venous Drainage For Extracorporeal Membrane Oxygenation.
Port J Card Thorac Vasc Surg
; 29(4): 51-54, 2023 Jan 14.
Article
in En
| MEDLINE
| ID: mdl-36640284
ABSTRACT
COVID-19 infection manifests as a spectrum of respiratory and vascular complications, including acute respiratory distress syndrome (ARDS) and pulmonary embolism. Herein, we describe a case of a healthy young male who presented with ARDS refractory to mechanical ventilation and concomitant bilateral pulmonary emboli managed with extracorporeal membrane oxygenation (ECMO) and embolectomy. The embolectomy and initial veno-venous ECMO configuration failed to correct the patient's hypoxemia despite maximal flows. This was thought to be due to a high-output state secondary to vasodilatory shock preventing adequate drainage from the existing single drainage ECMO cannulation, following which a second venous cannula was placed to form a unique veno-veno-venous ECMO circuit that resolved the persistent hypoxemia. The case underscores the importance of identifying embolic events and vasodilatory shock in COVID-19 patients, both of which need to be addressed simultaneously to avoid worsening right ventricular failure (via both mechanical and hypoxia-driven pathways) and the resulting veno-arterial ECMO along with its associated complications.
Full text:
1
Database:
MEDLINE
Main subject:
Pulmonary Embolism
/
Respiratory Distress Syndrome
/
Respiratory Insufficiency
/
Extracorporeal Membrane Oxygenation
/
COVID-19
Type of study:
Etiology_studies
/
Prognostic_studies
Limits:
Humans
/
Male
Language:
En
Journal:
Port J Card Thorac Vasc Surg
Year:
2023
Type:
Article
Affiliation country:
United States