Zhang JC, Li T. Delayed retroperitoneal hemorrhage during extracorporeal membrane oxygenation in COVID-19 patients: A case report and literature review. World J Clin Cases 2021; 9(19): 5203-5210 [PMID: 34307568 DOI: 10.12998/wjcc.v9.i19.5203]
Corresponding Author of This Article
Tong Li, MD, MSc, Research Associate, Department of Critical Care Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. drli@zju.edu.cn
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jul 6, 2021; 9(19): 5203-5210 Published online Jul 6, 2021. doi: 10.12998/wjcc.v9.i19.5203
Delayed retroperitoneal hemorrhage during extracorporeal membrane oxygenation in COVID-19 patients: A case report and literature review
Jing-Chen Zhang, Tong Li
Jing-Chen Zhang, Tong Li, Department of Critical Care Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Author contributions: Zhang JC generated the idea of the case report and was the consultant in charge of patients; Zhang JC reviewed the case notes of patients and wrote the original draft of the case presentation; Li T significantly revised the original draft and added the conclusions and references; All authors contributed to the final version of the manuscript.
Informed consent statement: The patient gave consent for publication of this case report and images.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tong Li, MD, MSc, Research Associate, Department of Critical Care Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. drli@zju.edu.cn
Received: January 27, 2021 Peer-review started: January 27, 2021 First decision: February 11, 2021 Revised: February 21, 2021 Accepted: May 15, 2021 Article in press: May 15, 2021 Published online: July 6, 2021 Processing time: 147 Days and 16.9 Hours
Abstract
BACKGROUND
Retroperitoneal hemorrhage (RPH) is a rare and severe complication in patients undergoing extracorporeal membrane oxygenation (ECMO). Clinical diagnosis is difficult.
CASE SUMMARY
Three cases of RPH patients with corona virus disease-19 (COVID-19) were included in this study. All three suffered from respiratory failure, were treated with veno-venous or veno-arterial-venous ECMO, and experienced RPH during ECMO treatment. Two of the COVID-19 cases were diagnosed after the patients experienced abdominal pain. The other patient exhibited decreases in the ECMO circuit flow rate and hemoglobin level. Two cases were treated by transcatheter arterial embolization, and one was treated conservatively. The hemorrhage in each of the three cases did not deteriorate. Satisfactory treatment results were achieved for the three patients because of prompt diagnosis and treatment.
CONCLUSION
Although the incidence of RPH during ECMO treatment is low, the risk is increased by anticoagulant use and local mechanical injury. If declines in blood flow velocity and hemoglobin are detected, RPH should be considered, and prompt aggressive therapy should be started.
Core Tip: Retroperitoneal hemorrhage (RPH) is a rare complication during the application of extracorporeal membrane oxygenation (ECMO). Corona virus disease-19 (COVID-19) is often accompanied by coagulation disorders, and the use of heparin in patients with severe COVID-19 patients during ECMO treatment increases the bleeding risk. Three COVID-19 patients who experienced RPH during ECMO treatment were investigated. Nursing operations, lifting, and excessive examination are the main reasons for the occurrence of RPH. RPH should be promptly excluded in patients with decreased blood pressure, hemoglobin, and ECMO flow rate to avoid dangerous complications.
