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for extracorporeal cardiopulmonary resuscitation in the critical care unit. The condition eventually required amputation of both arms. A 62-year-old woman without a remarkable past medical history presented to a tertiary care center with cardiopulmonary arrest due to refractory ventricular fibrillation. She immediately underwent veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in combination with intra-aortic balloon pumping via the femoral arteries and vein. The patient had severe left ventricular dysfunction. She was given the first 3,000 units of unfractionated heparin (UFH) from a catheter inserted into the right femoral artery immediately before coronary angiography, which showed no significant stenosis. She received UFH 10,000 units/day via the right internal jugular vein for the H eparin-induced thrombocytopenia (HIT) is an immune-mediated complication triggered by the production of antibodies to platelet factor 4 (PF4)-heparin complexes. HIT reportedly occurs in up to 5% of patients exposed to heparin regardless of the dose, timing, or treatment route.1 HIT can cause arterial and venous thromboses with a mortality rate as high as 20%,2 and can occur in patients with no history of heparin exposure.3 A recent study demonstrated that anti-PF4 antibodies induced by PF4/polyanion complexes on bacterial surfaces were similar to HIT antibodies.4 We herein report a case of HIT involving no history of exposure to heparin or any recent recognized event such as infection. The present patient developed HIT-related gangrene in the bilateral arms. Heparin indication was driven by the need

Bilateral Arm Gangrene Associated With Heparin-Induced Thrombocytopenia After Extracorporeal Cardiopulmonary Resuscitation