Neurologically Devastating Intraparenchymal Hemorrhage in COVID-19 Patients on Extracorporeal Membrane Oxygenation: A Case Series.
Anticoagulants
/ adverse effects
Betacoronavirus
COVID-19
Cohort Studies
Coronavirus Infections
/ therapy
Extracorporeal Membrane Oxygenation
/ adverse effects
Fatal Outcome
Female
Heparin
/ adverse effects
Humans
Intracranial Hemorrhages
/ diagnostic imaging
Male
Middle Aged
Pandemics
Pneumonia, Viral
/ therapy
Respiratory Distress Syndrome
/ therapy
Retrospective Studies
SARS-CoV-2
COVID-19
Extracorporeal membrane oxygenation
Intracranial hemorrhage
Intraparenchymal hemorrhage
Patient selection
Resource allocation
SARS-CoV-2
Journal
Neurosurgery
ISSN: 1524-4040
Titre abrégé: Neurosurgery
Pays: United States
ID NLM: 7802914
Informations de publication
Date de publication:
01 08 2020
01 08 2020
Historique:
received:
21
04
2020
accepted:
21
04
2020
pubmed:
20
5
2020
medline:
31
7
2020
entrez:
20
5
2020
Statut:
ppublish
Résumé
Extracorporeal membrane oxygenation (ECMO) represents a life-saving therapy in cases of refractory hypoxia and has been utilized in patients suffering from the most severe forms of coronavirus disease 2019 (COVID-19). A strikingly high mortality rate of 94% was described in early reports of patients with COVID-19 transitioned to ECMO. Later case reports and series demonstrating successful recovery from COVID-19 after ECMO have revived interest in this therapeutic modality, including the recent approval of ECMO for COVID-19 patients by the Food and Drug Administration (FDA). Here, we present the first reports of devastating intracranial hemorrhage as a complication of veno-venous (VV) ECMO in two COVID-19 patients. We performed a retrospective analysis of 2 cases of devastating intracranial hemorrhage in patients on VV-ECMO for the treatment of COVID-19. Collected data included clinical history, laboratory results, treatment, and review of all available imaging. Both patients demonstrated activated partial thromboplastin times (aPTT) within an appropriate therapeutic range. No risk factors that clearly predicted likelihood of this complication were identified. Understanding the complications of ECMO in this cohort and developing therapeutic algorithms to aid in optimal patient selection will be critical in the limited resource setting experienced as a result of global pandemic. We propose the use of head computed tomography (CT) to identify devastating neurological complications as early as possible, aiding in the resource allocation of ECMO machines to the most appropriately selected patients.
Sections du résumé
BACKGROUND AND IMPORTANCE
Extracorporeal membrane oxygenation (ECMO) represents a life-saving therapy in cases of refractory hypoxia and has been utilized in patients suffering from the most severe forms of coronavirus disease 2019 (COVID-19). A strikingly high mortality rate of 94% was described in early reports of patients with COVID-19 transitioned to ECMO. Later case reports and series demonstrating successful recovery from COVID-19 after ECMO have revived interest in this therapeutic modality, including the recent approval of ECMO for COVID-19 patients by the Food and Drug Administration (FDA). Here, we present the first reports of devastating intracranial hemorrhage as a complication of veno-venous (VV) ECMO in two COVID-19 patients.
CLINICAL PRESENTATION
We performed a retrospective analysis of 2 cases of devastating intracranial hemorrhage in patients on VV-ECMO for the treatment of COVID-19. Collected data included clinical history, laboratory results, treatment, and review of all available imaging. Both patients demonstrated activated partial thromboplastin times (aPTT) within an appropriate therapeutic range. No risk factors that clearly predicted likelihood of this complication were identified.
CONCLUSION
Understanding the complications of ECMO in this cohort and developing therapeutic algorithms to aid in optimal patient selection will be critical in the limited resource setting experienced as a result of global pandemic. We propose the use of head computed tomography (CT) to identify devastating neurological complications as early as possible, aiding in the resource allocation of ECMO machines to the most appropriately selected patients.
Identifiants
pubmed: 32424429
pii: 5840444
doi: 10.1093/neuros/nyaa198
pmc: PMC7313766
doi:
Substances chimiques
Anticoagulants
0
Heparin
9005-49-6
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
E147-E151Informations de copyright
Copyright © 2020 by the Congress of Neurological Surgeons.
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