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

Authors

Bindu Akkanti
Joseph Zwischenberger
Mark T Warner
Kha Dinh
Rahat Hussain
Farah Kazzaz
Pascal Kingah
Lisa M Janowiak
Biswajit Kar
Igor D Gregoric

Language

English

Publication Date

9-1-2022

Journal

The Journal of Extracorporeal Technology

DOI

10.1182/ject-235-238

PMID

36742217

PMCID

PMC9891489

PubMedCentral® Posted Date

September 2022

PubMedCentral® Full Text Version

Post-print

Abstract

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.

Keywords

COVID-19, pulmonary embolism, ECMO, thrombolysis, blood clot

Published Open-Access

yes

Recommended Citation

Akkanti, Bindu; Zwischenberger, Joseph; Warner, Mark T; et al., "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" (2022). Faculty, Staff and Student Publications. 607.
https://digitalcommons.library.tmc.edu/uthmed_docs/607