Fatal Hemothorax Following Complicated VV-ECMO Cannulation in Anticoagulated COVID-19 Patient

Strategic Insights -

A new study highlights the risks associated with ventilator-associated complications in COVID-19 patients, emphasizing the need for a safety protocol during extracorporeal membrane oxygenation (ECMO) insertion and careful assessment of bleeding risk in anticoagulated patients. The research, published in Forensic Science, Medicine and Pathology, details a case of a man on dual antiplatelet therapy who was hospitalized with severe COVID-19 pneumonia and died despite attempts at resuscitation after a guidewire perforated his right internal jugular vein during ECMO catheter insertion.

Key Takeaways:

  • Researchers from the Graduate School of Medical and Dental Sciences, Tokyo, Japan, presented a case of a fatal hemothorax resulting from a guidewire perforating the right internal jugular vein during VV-ECMO cannulation in an anticoagulated patient with severe COVID-19 pneumonia.
  • The patient was treated with standard therapy, including apixaban for suspected coagulopathy, but developed acute onset of hypotension and bradycardia, progressing to cardiac arrest.
  • Postmortem computed tomography revealed a large hemothorax and a guidewire penetrating the right pleural cavity, leading to an autopsy that confirmed an injured right internal jugular vein, a hematoma, and a hemothorax.
  • Histology of the lung revealed inflammatory cell infiltration and fibrosis, consistent with acute respiratory distress syndrome (ARDS).
  • The direct cause of death was hemorrhagic shock and respiratory failure due to a large hemothorax resulting from a guidewire perforation during VV-ECMO catheter insertion.
  • The research emphasizes the necessity of a safety protocol during ECMO insertion and assessment of bleeding risk in patients with COVID-19 receiving anticoagulant therapy.
  • Engineer Shutaro Nagano led the study, which includes co-authors Homare Kaga, Yohsuke Makino, Koichi Uemura, and Kana Unuma.

Statistics:

  • The patient was on dual antiplatelet therapy and had been hospitalized with severe COVID-19 pneumonia.
  • 2 days post-mortem, an autopsy was performed, revealing an injured right internal jugular vein, a hematoma, and a hemothorax.
  • The lung histology showed inflammatory cell infiltration and fibrosis, consistent with ARDS.
  • The direct cause of death was hemorrhagic shock and respiratory failure due to a large hemothorax resulting from a guidewire perforation during VV-ECMO catheter insertion.

Sources:

  • "Fatal hemothorax following complicated VV-ECMO cannulation in an anticoagulated patient with severe COVID-19 pneumonia." Forensic Science, Medicine and Pathology, 2025.
  • NewsRx. Recent Findings in COVID-19 Described by Researchers from Graduate School of Medical and Dental Sciences (Fatal hemothorax following complicated VV-ECMO cannulation in an anticoagulated patient with severe COVID-19 pneumonia). Medical Letter on the CDC & FDA. October 26, 2025; p 139.