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Pulmonary Embolism in COVID-19 Treated with VA-ECLS and Catheter tPA

Arda Akoluk1, Usman Mazahir2, Steven Douedi1

  • 1Department of Medicine, Hackensack Meridian Health, Jersey Shore University Medical Center, Neptune NJ, USA.

Clinical Medicine Insights. Circulatory, Respiratory and Pulmonary Medicine
|September 21, 2020
PubMed

Insights

This case study details the successful treatment of a massive pulmonary embolism in a COVID-19 patient using systemic thrombolysis, VA-ECLS, and catheter-directed thrombolysis. The approach demonstrated an acceptable bleeding risk, offering a viable option for severe COVID-19 complications.

Area of Science:

  • Critical Care Medicine
  • Cardiology
  • Infectious Diseases

Background:

  • COVID-19 pandemic highlights the need to understand severe manifestations.
  • Inflammatory dysregulation and viral immune evasion are key to COVID-19 severity.
  • Massive pulmonary embolism (PE) is a critical complication of COVID-19.

Observation:

  • A COVID-19 patient presented with massive PE.
  • Treatment involved a multi-modal approach: systemic thrombolysis, VA-ECLS, and catheter-directed thrombolysis.
  • The patient was discharged on warfarin for anticoagulation.

Findings:

  • Successful management of massive PE in a COVID-19 patient.
  • Catheter-directed thrombolysis showed acceptable bleeding risk with mechanical circulatory support.
  • Meticulous vascular access and dose monitoring are crucial for safety.

Implications:

  • This case suggests a potential treatment strategy for COVID-19 associated massive PE.
  • Catheter-directed thrombolysis can be safely employed alongside VA-ECLS.
  • Further research is warranted to validate this approach in larger cohorts.
Abstract

Keywords:
COVID-19VA-ECMOpulmonary embolismtPAthrombolysis

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