Disseminated Gestational Trophoblastic Disease and Diffuse Alveolar Hemorrhage Treated With Extracorporeal Membrane Oxygenation

Abstract

Late-stage gestational trophoblastic disease (GTD) bears poor prognosis including acute respiratory distress syndrome (ARDS), multiorgan failure, and death. There are currently no reports of extracorporeal membrane oxygenation (ECMO) therapy for respiratory failure due to disseminated GTD in post-partum patients. We present a case of newly diagnosed disseminated GTD progressing to ARDS secondary to diffuse alveolar hemorrhage (DAH) for which veno-venous ECMO was successfully implemented. ECMO is an accepted modality for ARDS refractory to medical therapy. Controversy persists regarding post-partum patient selection as contraindications to ECMO include known poor prognosis. Our case herein suggests that ECMO is an acceptable treatment modality for patients with acute respiratory failure secondary to disseminated GTD. The indications and contraindications for ECMO warrant further discussion and research for post-partum patients.

Acute cardiopulmonary failure in a young woman with high-risk gestational trophoblastic neoplasia: A case of induction chemotherapy during extracorporeal membrane oxygenation

“…When her hypoxia increased despite lung-protective ventilation and permissive hypercarbia, ECMO was initiated. Early use of ECMO in GTN with pulmonary lesions has been recommended as a treatment consideration ( Kelly et al, 1990 , Montrief et al, 2020 ), as positive pressure ventilation in patients with pulmonary tumor burden can lead to barotrauma and pulmonary hemorrhage ( Kelly et al, 1990 ). Our patient stabilized quickly once ECMO was initiated.…”