Other bulletins in this series include:

Breast Surgery

Thursday, 19 November 2020

Spontaneous hemothorax in 4 COVID-19 ARDS patients on VV-ECMO revealing pulmonary artery aneurysms

 

Spontaneous hemothorax in 4 COVID-19 ARDS patients on VV-ECMO revealing pulmonary artery aneurysms

 

by Cyrielle Desnos, Samia Boussouar, Guillaume Hekimian, Alban Redheuil and Alain Combes 

 

Critical Care volume 24, Article number: 638 (2020)

 

COVID-19 pneumonia is a cause of severe ARDS. Its pathophysiology involves endothelial dysfunction and angiogenesis related to ACE-2 receptor, the host-cell receptor for SARS-CoV-2, expressed by endothelial cells, which may lead to thrombosis or hemorrhage [1].

This case series describes the presentation of COVID-19 patients who had unusual spontaneous hemothorax while on veno-venous extra corporeal membrane oxygenation (VV-ECMO) for severe ARDS. In accordance with French legislation, only non-opposition of patient’s surrogate for utilization of the deidentified data was obtained. The ICU database was registered with the national data protection authority (CNIL 1950673). From February to September 2020, 62 patients with confirmed COVID-19-related severe ARDS requiring VV-ECMO were transferred and treated in our tertiary care ICU, of whom 4 had spontaneous hemothorax.

Ages were 33, 63, 48 and 46 years; 2 patients were women. None of them had pulmonary embolism on previous CT angiography, and they had received continuous infusion of unfractionated heparin at high preventive dose according to international expert guidelines [2]. They were on VV-ECMO for 3, 9, 22 and 28 days at the time of the hemothorax onset. In all four patients, hemothorax was revealed by shock, both hemorrhagic and obstructive by compression of the mediastinum, requiring high doses of catecholamine and massive packed red blood cells transfusion. One patient experienced cardiac arrest shortly after shock onset, resuscitated after chest drainage. On chest CT scan, vascular lung abnormalities were very similar in the 4 patients, including peripheral medium and small pulmonary artery branches aneurysms, one of them also having renal and diaphragmatic artery aneurysms (Fig. 1). Three of the patients underwent salvage radioembolization, one of them survived to this episode without relapse, and hemothorax was fatal for the 3 others…


No comments: