key: cord-1033927-908aok8o
authors: Guo, Shao-Hui; Zhu, Sheng-Mei; Yao, Yong-Xing
title: Giant Retroperitoneal Hematoma during Extracorporeal Membrane Oxygenation in a Patient with 2019-Coronavirus Pneumonia
date: 2020-06-03
journal: J Cardiothorac Vasc Anesth
DOI: 10.1053/j.jvca.2020.05.039
sha: da41a5280253b0dae0fbd3a649e716c8dee4c8cb
doc_id: 1033927
cord_uid: 908aok8o

nan

A 71-YEAR-OLD man was admitted to the intensive care unit because of severe bilateral pneumonia resulting from COVID-19. His chief complaints were persistent fever, cough, and shortness of breath. Thoracic computed tomography showed bilateral multiple ground-glass opacities. An arterial blood gas analysis demonstrated a low oxygenation index. The patient received high-flow oxygen therapy via a nasal cannula to maintain his oxygen saturation (SpO 2 ) above 90%. After receiving supportive care for 2 days, the patient's respiratory function deteriorated further. 2 Endotracheal intubation was performed, but the patient's SpO 2 remained approximately 70% despite mechanical ventilation with 100% oxygen. Therefore, percutaneous veno-venous extracorporeal membrane oxygenation (ECMO) was initiated. Activated partial thromboplastin time was targeted to 60 s using a heparin infusion. Progressive hypotension without apparent cause developed 7 days after ECMO was begun. What is the diagnosis?

Acute respiratory distress syndrome and profound hypoxemia are the main causes of death in COVID-19 pneumonia. 1 Despite the wide use of mechanical ventilation with low-volume, low-pressure, and prone position ventilation strategies, the mortality is still as high as 60% in severe cases. 2 In such situations, ECMO might be a life-saving measure but it is also associated with hemorrhagic complications. 3, 4 However, owing to a relatively complex management, various complications may occur during ECMO support. 5, 6 Abdominal computed tomography revealed a large cystic retroperitoneal mass with extravasation of contrast consistent with a retroperitoneal hematoma. The patient remained hypotensive despite volume resuscitation with crystalloid and packed red blood cell transfusion. An intravenous infusion of norepinephrine was required to temporize the hypotension, but serum lactate concentration continued to increase. The right internal iliac artery was occluded successfully in the angiography suite, and his hemodynamics stabilized. After the procedure, he was returned to the intensive care Computed tomography scan showing a giant cystic density shadow in the right retroperitoneal renal space, with leakage of contrast medium after enhancement.

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