Mediastinal hemorrhage during extracorporeal membrane oxygenation

Area of Science:

• Cardiology
• Pulmonology
• Critical Care Medicine

Background:

• Extracorporeal membrane oxygenation (ECMO) is a life-support technology used for severe respiratory or cardiac failure.
• Patients on ECMO often require anticoagulation, increasing bleeding risks.
• Barotrauma, lung injury from positive pressure ventilation, is a known complication in critically ill patients.

Observation:

• A case of mediastinal hemorrhage and pneumatocele bleeding in a patient on ECMO is presented.
• Computerized tomography (CT) of the chest confirmed the diagnosis.
• The patient was anticoagulated with heparin for ECMO support.

Findings:

• Barotrauma to the lungs is identified as the likely inciting event for the hemorrhage.
• Hemorrhage occurred in the mediastinum and a pneumatocele.
• The complication arose in the context of heparinization for ECMO.

Implications:

• This case underscores the importance of early ECMO initiation to mitigate pulmonary and mediastinal barotrauma.
• Prompt diagnosis and management of bleeding complications during ECMO are critical.
• Understanding the interplay between barotrauma, anticoagulation, and ECMO is vital for patient outcomes.