ABSTRACT
Neck swelling during venovenous extracorporeal membrane oxygenation (VV-ECMO) usually heralds the development of potentially serious complications, including superior vena cava (SVC) syndrome, hematoma, and/or angioedema. In this case report, we describe a 43-year-old male patient who had received VV-ECMO support for the coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome. During his hospitalization, he developed acute onset of neck swelling after two weeks of VV-ECMO and two days after a tracheostomy. Clinical examination and investigations were performed to exclude ECMO-related SVC syndrome and tracheostomy-related complications. Consequently, it was discovered the patient had developed COVID-19-related subacute thyroiditis with enlargement of both thyroid glands. Conservative management, including the use of continued glucocorticoids, raising the head of the bed, and observing for complications of thyroiditis, was undertaken. Eventually, this patient's neck swelling resolved on its own, and he was eventually decannulated from ECMO several weeks later. Our case report highlights the differential diagnosis of neck swelling during VV-ECMO and considers the evaluation of different etiologies.
ABSTRACT
INTRODUCTION: Little is still known about the prognostic impact of incident arrhythmias in hospitalized patients with COVID-19. The aim of this study was to evaluate the incidence and predictors of sustained tachyarrhythmias in hospitalized patients with COVID-19, and their potential association with disease severity and in-hospital mortality. MATERIALS AND METHODS: This was a retrospective multicenter observation study including consecutive patients with laboratory confirmed COVID-19 admitted to emergency department of ten Italian Hospitals from 15 February to 15 March 2020. The prevalence and the type of incident sustained arrhythmias have been collected. The correlation between the most prevalent arrhythmias and both baseline characteristics and the development of ARDS and in-hospital mortality has been evaluated. RESULTS: 414 hospitalized patients with COVID-19 (66.9 ± 15.0 years, 61.1% male) were included in the present study. During a median follow-up of 28 days (IQR: 12-45), the most frequent incident sustained arrhythmia was AF (N: 71; 17.1%), of which 50 (12.1%) were new-onset and 21 (5.1%) were recurrent, followed by VT (N: 14, 3.4%) and supraventricular arrhythmias (N: 5, 1.2%). Incident AF, both new-onset and recurrent, did not affect the risk of severe adverse events including ARDS and death during hospitalization; in contrast, incident VT significantly increased the risk of in-hospital mortality (RR: 2.55; P: .003). CONCLUSIONS: AF is the more frequent incident tachyarrhythmia; however, it not seems associated to ARDS development and death. On the other hand, incident VT is a not frequent but independent predictor of in-hospital mortality among hospitalized COVID-19 patients.