case_images: PMC9949976_01
case_images: Presentation of patient's time course of disease since hospital admission (day 0). ICU, intensive care unit; NIV, noninvasive ventilation; HFNC, high-flow nasal cannula; PCR, polymerase chain reaction; BAL, bronchial lavage sampling; vv-ECMO, veno-venous extracorporeal membrane oxygenation; RBC, red blood cell transfusion; ERCP, endoscopic retrograde cholangiopancreatography; NAVA, neurally adjusted ventilator assist; pSO
  2
  , partial oxygen saturation.
case_images: 10-1055-a-2008-4367-i22090040-1.jpg
case_images: PMC9949976_01_10-1055-a-2008-4367-i22090040-1.jpg
case_images: FI22090040-1
case_images: Due to refractory hypoxemia, therapy with ECMO, cortisone, and prone positioning were initiated and adequate gas exchange could be restored immediately ( Fig. 1 ). Forty-seven days after the start of ECMO therapy, endoscopic papillotomy for hyperbilirubinemia due to sclerosing cholangitis had to be performed (endoscopic retrograde cholangiopancreatography [ERCP] picture is shown in right part of Fig. 1 ). Supplementary Fig. S1 ). Fig. S1 ). Following the last dose, GI bleeding stopped and no further blood transfusions were necessary for several days. On day 110 the patient could be discharged from the ICU to a rehabilitation facility in stable condition ( Fig. 1 ).
case_images: von Willebrand factor (VWF) multimer distributions on day 3 after bleeding occurred under and after ECMO therapy compared to healthy control. ECMO, extracorporeal membrane oxygenation; HMWMM, high molecular weight multimers.
case_images: 10-1055-a-2008-4367-i22090040-2.jpg
case_images: PMC9949976_01_10-1055-a-2008-4367-i22090040-2.jpg
case_images: FI22090040-2
case_images: Multimer analysis confirmed the diagnosis with abnormal distribution and nearly complete absence of HMWM compared to healthy controls ( Fig. 2 ). Multimer analysis 1 week after ECMO decannulation showed an adequate reappearance of HMWM ( Fig. 2 ).