Ventilatory Failure And Pulmonary Embolism In Covid-19 Requiring Enhanced Venous Drainage For Extracorporeal Membrane Oxygenation

Authors

  • Khawaja M. Talha Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA https://orcid.org/0000-0003-0351-4464
  • Joseph M. Brewer Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
  • Jay G. Shake Division of Cardiothoracic Surgery, Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
  • Ashok C. Jeyakumar Division of Cardiothoracic Surgery, Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
  • Adam N. Protos Division of Cardiothoracic Surgery, Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA https://orcid.org/0000-0003-0977-4195
  • Gabriel A. Hernandez Divsion of Cardiovascular Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA https://orcid.org/0000-0001-5584-9536

DOI:

https://doi.org/10.48729/pjctvs.298

Keywords:

extracorporeal membrane oxygenation, pulmonary embolism, COVID-19, thrombectomy

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.

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References

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Published

14-01-2023

How to Cite

1.
Talha KM, Brewer JM, Shake JG, Jeyakumar AC, Protos AN, Hernandez GA. Ventilatory Failure And Pulmonary Embolism In Covid-19 Requiring Enhanced Venous Drainage For Extracorporeal Membrane Oxygenation. Rev Port Cir Cardiotorac Vasc [Internet]. 2023 Jan. 14 [cited 2023 Feb. 3];29(4):51-4. Available from: https://pjctvs.com/index.php/journal/article/view/298

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Clinical Cases

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