COVID-19 and Blood Clots: A Report of Massive Pulmonary Embolism in COVID-19 Patient Supported on Veno-Venous ECMO and the Utility of Thrombolysis

COVID-19 morbidity and mortality are not equivalent to other etiologies of acute respiratory distress syndrome (ARDS) as fulminant activation coagulation can occur, thereby resulting in widespread microvascular thrombosis consumption factors. A 53-year-old female presented an emergency center on two occasions with progressive gastrointestinal symptoms. She was diagnosed pneumonia admitted a satellite intensive care unit hypoxemic failure. intubated mechanically ventilated, but her ARDS progressed over the next 48 hours. The patient emergently cannulated for veno-venous extracorporeal membrane oxygenation (V-V ECMO) transferred our hospital. profound shock requiring multiple vasopressors hemodynamic support worsening clinical status arrival. On bedside echocardiography, she found have massive pulmonary embolism clot-in-transit visualized right atrium ventricular outflow tract. After multidisciplinary discussion, systemic thrombolytic therapy administered. patient’s hemodynamics improved were discontinued. This case illustrates utility echocardiography determination, need continued vigilance systematic evaluation unstable patients unit, use thrombolytics during V-V ECMO novel disease process evolving understanding.