Intestinal Ischaemia and Perforation After Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO) for Acute Exacerbation of Interstitial Lung Disease: An Autopsy Case.

A 75-year-old man with interstitial lung disease was admitted with an acute exacerbation and severe hypoxemic respiratory failure. During intensive care management, he developed acute myocardial infarction, required veno-venous extracorporeal membrane oxygenation and later underwent continuous haemodiafiltration for an acute kidney injury. A pulmonary embolism, gastrointestinal bleeding and intestinal perforation subsequently occurred, and the patient died of septic shock on day 40 of hospitalisation. An autopsy showed diffuse alveolar damage superimposed on a usual interstitial pneumonia pattern, intra-alveolar haemorrhage, a subacute myocardial infarction, pulmonary arterial thrombi, a terminal ileal perforation with transmural necrosis and microthrombi in the intestinal wall. This case illustrates the difficulty of balancing thrombosis and bleeding during and after extracorporeal support for an acute exacerbation of interstitial lung disease and highlights the need for early suspicion of intestinal ischaemia in patients receiving extracorporeal membrane oxygenation who exhibit unexplained anaemia, gastrointestinal bleeding, worsening sepsis, or rising lactate levels, particularly during deep sedation.