Abstract BACKGROUND AND IMPORTANCE Extracorporeal membrane oxygenation (ECMO) represents a life-saving therapy in cases of refractory hypoxia and has been utilized in patients suffering from the most severe forms of coronavirus disease 2019 (COVID-19). A strikingly high mortality rate of 94% was described in early reports of patients with COVID-19 transitioned to ECMO. Later case reports and series demonstrating successful recovery from COVID-19 after ECMO have revived interest in this therapeutic modality, including the recent approval of ECMO for COVID-19 patients by the Food and Drug Administration (FDA). Here, we present the first reports of devastating intracranial hemorrhage as a complication of veno-venous (VV) ECMO in two COVID-19 patients. CLINICAL PRESENTATION We performed a retrospective analysis of 2 cases of devastating intracranial hemorrhage in patients on VV-ECMO for the treatment of COVID-19. Collected data included clinical history, laboratory results, treatment, and review of all available imaging. Both patients demonstrated activated partial thromboplastin times (aPTT) within an appropriate therapeutic range. No risk factors that clearly predicted likelihood of this complication were identified. CONCLUSION Understanding the complications of ECMO in this cohort and developing therapeutic algorithms to aid in optimal patient selection will be critical in the limited resource setting experienced as a result of global pandemic. We propose the use of head computed tomography (CT) to identify devastating neurological complications as early as possible, aiding in the resource allocation of ECMO machines to the most appropriately selected patients.

中文翻译：

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体外膜氧合治疗 COVID-19 患者的神经学破坏性脑实质内出血：病例系列

摘要 背景和重要性 体外膜肺氧合 (ECMO) 是难治性缺氧情况下的一种挽救生命的疗法，已被用于患有最严重的 2019 冠状病毒病 (COVID-19) 的患者。在 COVID-19 患者转为 ECMO 的早期报告中描述了 94% 的惊人高死亡率。后来的病例报告和系列证明在 ECMO 重新引起人们对这种治疗方式的兴趣后从 COVID-19 中成功康复，包括最近美国食品和药物管理局 (FDA) 批准 ECMO 用于 COVID-19 患者。在这里，我们首次报道了两名 COVID-19 患者的破坏性颅内出血是静脉-静脉 (VV) ECMO 的并发症。临床报告 我们对 2 例使用 VV-ECMO 治疗 COVID-19 的破坏性颅内出血进行了回顾性分析。收集的数据包括临床病史、实验室结果、治疗和所有可用影像的审查。两名患者均表现出在适当治疗范围内的活化部分凝血活酶时间 (aPTT)。没有确定明确预测这种并发症可能性的风险因素。结论 在全球大流行导致资源有限的情况下，了解该队列中 ECMO 的并发症并开发治疗算法以帮助优化患者选择至关重要。我们建议使用头部计算机断层扫描 (CT) 来尽早识别破坏性的神经系统并发症，