Successful application of extracorporeal membrane oxygenation due to pulmonary hemorrhage secondary to granulomatosis with polyangiitis

Abstract

Extracorporeal membrane oxygenation (ECMO) is increasingly applied in adults with acute refractory respiratory failure that is deemed reversible. Bleeding is the most frequent complication during ECMO support. Severe pre-existing bleeding has been considered a contraindication to ECMO application. Nevertheless, there are cases of successful ECMO application in patients with multiple trauma and hemorrhagic shock or head trauma and intracranial hemorrhage. ECMO has proved to be life-saving in several cases of life-threatening respiratory failure associated with pulmonary hemorrhage of various causes, including granulomatosis with polyangiitis (Wegener’s disease). We successfully applied ECMO in a 65-year-old woman with acute life-threatening respiratory failure due to diffuse massive pulmonary hemorrhage secondary to granulomatosis with polyangiitis, manifested as severe pulmonary-renal syndrome. ECMO sustained life and allowed disease control, together with plasmapheresis, cyclophosphamide, corticoids, and renal replacement therapy. The patient was successfully weaned from ECMO, extubated, and discharged home. She remains alive on dialysis at 17 months follow-up.

Extracorporeal Life Support in Hemorrhagic Conditions: A Systematic Review

“…Through the literature search, 614 articles were found in Pubmed, 488 in Medline, 869 in Embase, and 5 by searching the references in publications included in the analysis (Figure 1). The following subgroups were created based on the bleeding conditions: 1 patient with tracheal injury, 13 11 patients with postpartum or cesarean delivery hemorrhage, 14–19 7 patients with intracranial hemorrhage, 20–25 53 patients with pulmonary hemorrhage, 5,26–66 13 patients with postpulmonary endarterectomy bleeding, 67–72 and 96 patients with bleeding trauma 51,73–96 (Table 1; see Supplementary Tables 1–5, Supplemental Digital Content, http://links.lww.com/ASAIO/A515). Overall, 183 patients were identified in 86 included publications, namely, 74 case reports, 4 case series, 7 retrospective database observational studies, and 1 preliminary results of ongoing study.…”

“…The indications for pulmonary support included adult (or acute) respiratory distress syndrome resulting from intrapulmonary hemorrhage or trauma, 23,45,98 pneumonia in a patient with intracranial hemorrhage, 21 neurogenic pulmonary edema after trauma, 25 and hypoxic respiratory failure 26,29,33,37,40,43,44,46,53,58,59,68,69,71 (Supplemental Tables 1–5, Supplemental Digital Content, http://links.lww.com/ASAIO/A515).…”

Use of Thromboelastogram in Venovenous Extracorporeal Membrane Oxygenation for a Patient with Pulmonary Hemorrhage due to Microscopic Polyangiitis

“…Use of VV-ECMO as a bridge therapy for pulmonary hemorrhage due to vasculitis has been reported in case reports [1–3]. This case report serves to demonstrate another successful case.…”

Extracorporeal membrane oxygenation in the management of granulomatosis with polyangiitis

“…A PubMed/Medline literature search was performed using the keywords: “Wegener's granulomatosis,” “Wegener's arteritis,” “granulomatosis with polyangiitis,” “extracorporeal membrane oxygenation,” and “ECMO” (cutoff date: July 21, 2020). A total of 12 papers reporting 13 patients (published between 1994 and 2017) were identified 4–15 …”

“…A total of 12 papers reporting 13 patients (published between 1994 and 2017) were identified. [4][5][6][7][8][9][10][11][12][13][14][15]…”