Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA.
Port J Card Thorac Vasc Surg. 2023 Jan 14;29(4):51-54. doi: 10.48729/pjctvs.298.
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.
COVID-19 感染表现为一系列呼吸系统和血管并发症，包括急性呼吸窘迫综合征（ARDS）和肺栓塞。在此，我们描述了一例健康年轻男性病例，他患有对机械通气无反应的 ARDS，同时伴有双侧肺栓塞，采用体外膜氧合（ECMO）和血栓切除术进行治疗。尽管采用了最大流量，但血栓切除术和最初的静脉-静脉 ECMO 配置仍未能纠正患者的低氧血症。这被认为是由于血管舒张性休克导致的高输出状态，这会阻止现有的单引流 ECMO 插管充分引流，随后放置第二个静脉插管以形成独特的静脉-静脉-静脉 ECMO 回路，从而解决持续的低氧血症。该病例强调了在 COVID-19 患者中识别栓塞事件和血管舒张性休克的重要性，这两者都需要同时解决，以避免右心室衰竭恶化（通过机械和缺氧驱动途径）以及由此产生的静脉-动脉 ECMO 及其相关并发症。
