Kun Li,1,* Xuejia Pan,2,* Tingting Liu,1 Dan Zhang,3 Saiping Jiang,4 Xueling Fang1 

1Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China; 2Department of Nursing, Hangzhou Xiaoying Community Health Service Center, Hangzhou, Zhejiang, People’s Republic of China; 3Department of Laboratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China; 4Department of Clinical Pharmacy, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Xueling Fang, Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79, Qingchun Road, Shangcheng District, Hangzhou, Zhejiang, People’s Republic of China, Email xuelingfang@zju.edu.cn Saiping Jiang, Department of Clinical Pharmacy, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79, Qingchun Road, Shangcheng District, Hangzhou, Zhejiang, People’s Republic of China, Email j5145@zju.edu.cn

Abstract: COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a respiratory illness with high mortality, especially among critically ill patients. The Extracorporeal Life Support Organization (ELSO) COVID-19 Interim Guidelines recommend extracorporeal membrane oxygenation (ECMO) for severe COVID-19 cases when the partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio remains below 80 mmHg despite conventional treatments. We present the case of a 62-year-old male with severe COVID-19 pneumonia who required veno-venous ECMO (V–V ECMO). During his treatment, he experienced an acute myocardial infarction, necessitating percutaneous coronary intervention and stent placement. Although initially a candidate for lung transplantation, complications related to myocardial infarction and heart failure led to delays. Management of anticoagulation and antiplatelet therapy was further complicated by thrombocytopenia secondary to both infection and ECMO therapy. Nevertheless, the patient remained on ECMO for 124 days without oxygenator replacement or significant bleeding events. This case underscores the successful long-term use of V–V ECMO in the face of COVID-19, myocardial infarction, and thrombocytopenia, emphasizing the value of multidisciplinary teamwork and individualized treatment strategies.

Keywords: infection, severe pneumonia, coronavirus disease 2019, respiratory failure, acute respiratory distress syndrome, extracorporeal membrane oxygenation, critical care, nursing, case report