• Keiichiro Shimoyama, Kazunari Azuma, and Jun Oda.
• Department of Emergency and Critical Care Medicine, Tokyo Medical University, 6-7-1, Nisi-Shinjuku, Shinjuku-Ku, Japan.
• Medicine (Baltimore). 2021 Dec 23; 100 (51): e28094e28094.

RationaleThe many deaths from coronavirus disease (COVID-19) since 2019 have caused global concern. Effective treatment has not yet been established; supportive care is the main treatment. It has been suggested that veno-venous extracorporeal membrane oxygenation (VV-ECMO) may be effective in severe cases that do not respond to ventilator management.Patient Concerns And DiagnosisWe report the case of a 68-year-old woman with severe respiratory failure due to COVID-19 who was treated with VV-ECMO but suffered from bleeding complications. She presented with multiple café-au-lait lesions and neurofibromas on her skin and was diagnosed pathologically as having neurofibromatosis type 1(NF1).Interventions And OutcomesAlthough she received appropriate anticoagulation therapy with heparin at the initiation of VV-ECMO, she had 5 episodes of severe bleeding, each requiring transcatheter arterial embolization and massive transfusion. In patients with NF1, vascular fragility has been noted due to vascular infiltration of neurofibromas and degeneration of vascular structures. Therefore, the causes of frequent bleeding complications may be related to the fragility of blood vessels in patients with NF1. VV-ECMO in patients with NF1 is likely to result in frequent bleeding complications and the need for massive transfusion.LessonWe propose non-anticoagulation treatment strategy for the management of VV-ECMO in patients with NF1. Especially under the COVID-19 pandemic, more careful consideration should be given to the indications for VV-ECMO in patients with NF1.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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