Utilization of Thromboelastogram and Inflammatory Markers in the Management of Hypercoagulable State in Patients with COVID-19 Requiring ECMO Support

The role of extracorporeal membrane oxygenation (ECMO) in the management of critically ill patients with COVID-19 is evolving. Extracorporeal support independently confers an increased predilection for thrombosis, which can be exacerbated by COVID-19-associated coagulopathy. We present the successfu...

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Bibliographic Details
Published in:Case reports in critical care 2021, Vol.2021, p.1-4
Main Authors: Smolarz, Angela, McCarthy, Paul, Shmookler, Aaron, Badhwar, Vinay, Hayanga, Awori J., Sakhuja, Ankit
Format: Article
Language:English
Subjects:
Blood clots
Body mass index
Case Report
Case reports
Coronaviruses
COVID-19
Intensive care
Pandemics
Patients
Plasma
Severe acute respiratory syndrome coronavirus 2
Thromboembolism
Thrombosis
Ultrasonic imaging
Veins & arteries
Ventilators
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Summary:The role of extracorporeal membrane oxygenation (ECMO) in the management of critically ill patients with COVID-19 is evolving. Extracorporeal support independently confers an increased predilection for thrombosis, which can be exacerbated by COVID-19-associated coagulopathy. We present the successful management of a hypercoagulable state in two patients who required venovenous ECMO for the treatment of COVID-19. This included monitoring inflammatory markers (D-dimer and fibrinogen), performing a series of therapeutic plasma exchange procedures, and administering high-intensity anticoagulation therapy and thromboelastography- (TEG-) guided antiplatelet therapy. TPE was performed to achieve goal D-dimer less than 3000 ng/mL D-dimer units (N≤232 ng/mL D-dimer units) and goal fibrinogen less than 600 mg/dL (N=200-400 mg/dL). These therapies resulted in improved TEG parameters and normalized inflammatory markers. Patients were decannulated after 37 days and 21 days, respectively. Post-ECMO duplex ultrasound of the upper and lower extremities and cannulation sites revealed a nonsignificant deep venous thrombosis at the site of femoral cannulation in patient 2 and no deep venous thrombosis in patient 1. The results of this case report show successful management of a hypercoagulable state among COVID-19 patients requiring ECMO support by utilization of inflammatory markers and TEG.
ISSN:2090-6420
2090-6439
DOI:10.1155/2021/8824531