Late Hemorrhagic Complication and Unilateral Neck Edema Related to Cannulation in Veno-Venous Extracorporeal Membrane Oxygenation (VV ECMO): A Case Report

TL;DR

A 20-year-old woman on VV ECMO developed late neck swelling and bleeding due to partial venous outflow obstruction, highlighting the need for careful cannula positioning.

Contribution

This case report presents a rare late complication of VV ECMO involving unilateral neck edema and hemoptysis due to venous outflow obstruction.

Findings

Unilateral neck swelling and tracheal deviation occurred due to partial venous outflow obstruction during VV ECMO.

Collateral vessel formation led to muscle swelling, small hemorrhages, and a bleeding mass in the throat.

The patient was successfully weaned off ECMO and recovered without further complications.

Abstract

We report a case of a late cannulation-related complication on veno-venous extracorporeal membrane oxygenation (VV ECMO), which includes unilateral neck swelling. A 20-year-old woman, post bone marrow transplantation, was admitted to the ICU with respiratory failure. On day 3, due to conventional support failure, VV ECMO was initiated. On day 2 of the ECMO run, significant right-sided neck swelling occurred, with a marked tracheal deviation to the left, which was accompanied by intensive hemoptysis. On day 5 of ECMO, the patient was successfully weaned off ECMO, decannulated without complications, and subsequently extubated. ​​​​​​​A multidisciplinary review of the case concluded that the complication was caused by the partial obstruction of venous outflow. Venous outflow impairment led to the formation of the collateral vessels on the right side of the neck. These changes caused muscle swelling, multiple small hemorrhages, and the formation of a new bleeding mass in the throat. ​​​​​​​

This case highlights the importance of taking into consideration a wide range of differential diagnoses for neck swelling during VV ECMO and the importance of drainage cannula positioning.

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