Standfirst; For critically ill COVID-19 patients, the incidence of thrombotic complications is reported to be remarkably high. We present the case of a 54-year-old female COVID-19 patient on extracorporeal membrane oxygenation who developed pronounced thrombosis. Successful percutaneous thrombectomy, using the AngioVac® suction device, was performed to remove the thrombi in toto and to prevent further fatal embolic events.
A 54-year-old woman was admitted to our hospital with a severe COVID-19 pneumonia (Panel A). Three days after admission, her respiratory situation deteriorated and the patient needed mechanical ventilation. In further course, sufficient gas exchange could not be established despite intensification of ventilation parameters and placing the patient in the intermittent prone position. Due to her young age and absence of severe comorbidities (diabetes), the decision was made to support her with veno-venous extracorporeal membrane oxygenation. During her hospital stay she developed a heparin-induced thrombocytopenia. Despite sufficient anticoagulation with argatroban, the patient developed multiple thrombi in the area of the inferior vena cava, the right atrium, and the pelvic veins (Panels C and D). A computed tomography angiography documented a central pulmonary artery embolism with occlusion of the lower right and middle pulmonary artery (Panel B). Since the respiratory situation had improved in the meantime, the decision was made to terminate extracorporeal membrane oxygenation and to perform a percutaneous thrombectomy during device explantation, using the AngioVac® suction device. After 1 min of aspiration through femoral access under transoesophageal echocardiographic control, thrombus formation could no longer be visualized (Panel E). The AngioVac® blood filter was flushed, permitting visualization of a large thrombus trapped on the filter (Panel F).
Acute infections are associated with an increased risk of venous thrombo-embolic events. In critically ill COVID-19 patients, in particular, the incidence of thrombotic complications as well as an abnormal procoagulant coagulation pattern is reported to be remarkably high. The presented case is intend to sensitize physicians to this complication in COVID-19 patients and to show the treatment routes.