[Introduction]During extracorporeal membrane oxygenation (ECMO), evaluating blood viscoelasticity from anticoagulation with heparin has been shown to lower the risk of hemorrhagic consequences. This study aimed to investigate the association between hemorrhagic complications during ECMO and different thromboelastography (TEG) parameters in patients with COVID-19. Furthermore, the ability of TEG parameters to predict hemorrhagic complications was investigated. [Methods]Between April 2020 and February 2021, we enrolled 18 patients who received veno-venous ECMO for severe COVID-19 and recorded 226 TEG measurements during ECMO at Fukuoka University Hospital’s ECMO Center. The days on which hemorrhage bleeding complications were observed were classified as hemorrhage, whereas the other days were classified as non-hemorrhage. Heparin dose, hematological findings, and TEG parameters were compared between the two groups and multivariate logistic regression analyses were performed to evaluate hemorrhage complication discrimination ability using the receiver operating characteristic curve. [Results]A total of 167 TEG measurements were investigated after excluding the exclusion criteria measurements. Hemorrhage occurred 17 times, and Δ CK-R.CKH-R, which indicates the action of heparin, showed significant discrimihemorrhageser (odds ratio: 1.03; 95% CI: 1.01–1.05; P<0.01). Δ CK-R.CKH-R was 0.66 in the area under the curve, indicating that the ideal cutoff value for hemorrhagic complications was 67.2 min (sensitivity: 0.35; specificity: 0.96). [Conclusion] This study revealed a possible association between Δ CK-R.CKH-R and the risk of hemorrhagic complications in the management of patients with severe COVID-19, with ECMO, using heparin as the anticoagulant. However, further research is warranted to investigate the infuluence of hemorrhagic complications predisposition other than heparin.

View full abstract

Stress, such as infection and ischemic heart disease, can cause thyroid storm. Thyroid storm occurs mostly from Graves’ disease, which may be unnoticed and undiagnosed. In recent years, there have been increasing reports of Graves’ disease developing after COVID-19 vaccination. Here, we report a case in which a patient developed thyroid storm after the first COVID-19 vaccination, and was subsequently diagnosed with Graves’ disease. The patient was a 67-year-old man with no medical history. He was admitted for emergency treatment due to fatigue and dyspnea that began the morningafter receiving a COVID-19 vaccination. Acute ischemic heart failure was diagnosed by electrocardiography and cardiac catheterization, and he was admitted to the ICU after treatment. Tachycardia continued from the time of admission, and he subsequently developed high fever. Thyroid function tests revealed thyroid storm and Graves’ disease. The development of thyroid storm after vaccination should be kept in mind as well as sudden illness and trauma.

View full abstract