Decompressive Laparotomy for Veno-Venous Extracorporeal Membrane Oxygenation Failure due to Intra-Abdominal Hypertension in Critically Ill COVID-19 Patient

The use of extracorporeal membrane oxygenation (ECMO) has increased over the course of the SARS-CoV-2 pandemic. Intra-abdominal hypertension resulting in abdominal compartment syndrome (ACS) during ECMO support is a rare but life-threatening complication, with previous case series describing mortality rates of 44%-100%. Bleeding complications, linked to both patient-related and device-related factors, also characterize prolonged ECMO support and have been reported in up to 60% of ECMO patients. We hereby describe a critically ill COVID-19 patient who underwent emergent bed-side decompressive laparotomy for acute ECMO failure related to the development of ACS. The discussion is focused on surgical considerations including the delicate balance between anticoagulation and thrombosis, as anticoagulation-free ECMO support may be required due to hemorrhagic complications.