COVID-19 infection triggered idiopathic capillary leak syndrome treated with ECMELLA

Idiopathic systemic capillary leak syndrome (ISCLS) is characterized by recurrent systemic capillary leakage and hypovolemic shock. We report a 59-year-old Caucasian man with ISCLS and persistent hypovolemic and cardiogenic shock after COVID-19 infection. Mechanical circulatory support was provided with veno-arterial extracorporeal membrane oxygenation and a microaxial pump. Massive fluid resuscitation was needed. Subsequent complications prolonged the intensive care treatment. Mechanical circulatory support was needed for 22 days. Cardiac function eventually fully recovered, and the patient survived without neurologic compromise. This case of severe ISCLS triggered by COVID-19 highlights that even the most severe hypovolemic and cardiogenic shock may be reversible in ISCLS. •COVID-19 vaccination and infection are potent triggers of ISCLS.•The lack of a causal therapy warrants maximum supportive therapy including temporary mechanical circulatory support.•Patients with severe ISCLS are prone to life threatening complications.•However, ISCLS is potentially completely reversible and good neurological outcome can be achieved.