Pedal gangrene in a patient with COVID-19 treated with prone positioning and extracorporeal membrane oxygenation

Siegel, Amanda P.; Rubaiay, Ammar Al; Adelsheimer, Andrew; Haight, John; Gawlik, Scott; Oropallo, Alisha

doi:10.1016/j.jvscit.2021.02.013

Cited by 4 publications

(4 citation statements)

References 24 publications

(30 reference statements)

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“…Management with VTE prophylaxis versus therapeutic anticoagulation, local wound care, and consideration of amputation based on severity of illness and functional status are all methods that have been utilized. 8 , 9 , 10 , 11 , 12 …”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, pedal gangrene associated with VTE in the context of COVID-19 infection has been reported in some case reports. 8 , 9 , 10 , 11 , 12 Currently, methods such as anticoagulation alone, mechanical thrombectomy, catheter-directed thrombolysis, prone positioning with veno-venous extracorporeal membrane oxygenation, and amputation have been trialed with varying levels of success. 8 , 9 , 10 , 11 , 12 In other similar reports, COVID-positive patients with concomitant VTE and arterial thromboembolism (ATE) ultimately required more proximal amputation in the acute setting.…”

Section: Introductionmentioning

confidence: 99%

“… 8 , 9 , 10 , 11 , 12 Currently, methods such as anticoagulation alone, mechanical thrombectomy, catheter-directed thrombolysis, prone positioning with veno-venous extracorporeal membrane oxygenation, and amputation have been trialed with varying levels of success. 8 , 9 , 10 , 11 , 12 In other similar reports, COVID-positive patients with concomitant VTE and arterial thromboembolism (ATE) ultimately required more proximal amputation in the acute setting. 9 , 13 , 14 Here we present the case of a 60-year-old male who presented with significant venous gangrene of the left lower extremity secondary to COVID-19 infection.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Venous gangrene associated with COVID-19: Successful limb preservation strategies with optimal wound management

Facciponte

Shaw

2022

Annals of Vascular Surgery - Brief Reports and Innovations

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Venous gangrene associated with COVID-19: Successful limb preservation strategies with optimal wound management

Facciponte

Shaw

2022

Annals of Vascular Surgery - Brief Reports and Innovations

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“…In this case, no angiogram was performed to identify a thrombus, furthermore, the gangrene was not progressive. He had recovered with no loss of life and limb [ 14 ]. However, in both our cases, an angiogram revealed thrombosis of common femoral and external iliac in case one, thrombosis below the popliteal trifurcation in case two.…”

Section: Discussionmentioning

confidence: 99%

Catastrophic Coronavirus Disease COVID Infection Leading to Gangrene of Foot in Peripartum Women

Vincent¹,

Elango²,

Rai³

et al. 2021

JOCR

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Introduction:Pregnancy is a physiologically hypercoagulable state and a coronavirus disease 2019 (COVID-19) infection adds to this burden by accentuating the coagulopathy. We report two cases of severe peri-partum COVID infection leading to extremity gangrene secondary to a pro-thrombotic coagulopathy. Case Report:A 37-year-old lady, day-2 postpartum, was brought with severe COVID infection & and respiratory failure. She developed progressive gangrene of the foot. A computed tomography (CT) angiogram confirmed the presence of thrombosis of the left external iliac & and common femoral artery. She was managed with catheter- directed thrombolysis and fasciotomy. The dry gangrene of the foot was managed with a Boyd’s amputation. At 1-year follow-up, she is ambulant with a healthy stump. Case Two: A 34-year-old lady, 36 weeks of gestation, presented with fulminant COVID infection with respiratory failure and pulmonary embolus. The lady developed gangrene of the B/L toes. A CT angiogram revealed thrombosis below the popliteal trifurcation in both limbs along with segmental pulmonary thrombo-embolism involving the right lung and multiple splenic infarcts. She succumbed to the overwhelming infection and sepsis. Discussion:The pathogenesis of coagulopathy in pregnant COVID patients is attributed to the hypercoagulable effect, which leads to thrombo-embolisms and limb ischemia following a cytokine storm syndrome in severe infections. To date, this is the first experience detailing distal limb gangrene in fulminant COVID infection in peri-partum women. Although, cases have been reported on distal limb gangrene in severe COVID infection among non-pregnant individuals. Conclusion:A multidisciplinary team must manage COVID infections in the third trimester. A prompt recognition of any forms of lethal coagulopathy and vigilant treatment will prevent loss of life. Keywords:Coronavirus diseaseCOVID, foot gangrene, pregnancy, coagulopathy.

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Multiple drugs

2021

Reactions Weekly

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Multiple drugsVarious toxicities: case report A 31-year-old man developed digital pedal gangrene and digital necrosis during treatment with epinephrine, phenylephrine and norepinephrine for hypotension. Additionally, he exhibited lack of efficacy with ceftriaxone and azithromycin, which was used as an empirical treatment and also exhibited lack of efficacy following an off-label treatment with chloroquine, thiamine, ascorbic acid and anakinra for coronavirus disease-2019 (COVID-19) [dosages and routes not stated].The man presented to the emergency department with a 2-day history of dry cough and 5-day history of fever. His medical history was significant for obesity and hypertension. On presentation, he was found to be hypoxic, febrile and tachycardic. He was admitted to the general medicine floor and started receiving empirical treatment with azithromycin and ceftriaxone. On admission, a nasal swab test was found to be positive for COVID-19. Therefore, he started receiving an off-label treatment with chloroquine, anakinra, thiamine and ascorbic acid [vitamin-C]. Despite treatment, he continued to have persistent fevers and developed acute hypoxaemia, indicating lack of efficacy following an off-label treatment with chloroquine, thiamine, ascorbic acid and anakinra.The man was then intubated and transferred to the ICU. He found to be hypotensive, and he was treated with infusions of epinephrine injection, phenylephrine and norepinephrine for 30 days. Additionally, he received heparin for deep venous thrombosis prophylaxis with goal activated partial thromboplastin time of 50-70 seconds. Despite high ventilator settings, medical therapy and prone positioning for an average of 15h intervals over 6 days, he remained with severe acute respiratory distress syndrome and respiratory acidosis. Therefore, he was placed on extracorporeal carbon dioxide removal. He was subsequently transitioned to venovenous extracorporeal membrane oxygenation (VV-ECMO) for refractory hypoxaemia and then started receiving an off-label treatment with methylprednisolone. After the initiation of ECMO, the heparin therapy was switched to argatroban. His ICU course was then complicated by new onset atrial fibrillation with emergent successful cardioversion. He was treated with amiodarone with improvement. On day 24 ECMO was successfully decannulated, and he was extubated on day 34. The podiatry team was consulted on day 35 for concern of new-onset digital pedal gangrene. It was noted that his feet were firmly pressed against the footboard of the hospital bed and not properly off-loaded. At this time, Z-flow boots for off-loading of the feet were placed on, and he started receiving treatment with local wound care with povidone iodine [Betadine] paint every other day. An increased digital necrosis was noted to the left plantar forefoot throughout the hospital course. The digital pedal gangrene and digital necrosis were attributed to the epinephrine, phenylephrine and norepinephrine therapy. After 55 days of hospital stay, he was discharged to acu...

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Pedal gangrene in a patient with COVID-19 treated with prone positioning and extracorporeal membrane oxygenation

Cited by 4 publications

References 24 publications

Venous gangrene associated with COVID-19: Successful limb preservation strategies with optimal wound management

Venous gangrene associated with COVID-19: Successful limb preservation strategies with optimal wound management

Catastrophic Coronavirus Disease COVID Infection Leading to Gangrene of Foot in Peripartum Women

Multiple drugs

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