The Successful Use of Extracorporeal Membrane Oxygenation in Systemic Lupus Erythematosus-Induced Diffuse Alveolar Haemorrhage
KeywordsAlveolar hemorrhage, extra corporeal membrane oxygenation, lupus
Diffuse alveolar haemorrhage (DAH) is a catastrophic pulmonary complication of systemic lupus erythematosus. It can result in refractory hypoxaemia despite mechanical ventilation. Increasing lung compliance and worsening pulmonary hypertension can potentiate cardiogenic shock from acute right ventricular failure. In such patients with cardiopulmonary collapse, veno-arterial (V-A) ECMO maybe a viable option that can provide the required haemodynamic support. However, the use of V-A ECMO in such patients is limited due to an associated increased risk of bleeding. Our case report describes the successful use of V-A ECMO without the use of systemic anticoagulation in a patient with DAH. Despite the absence of systemic anticoagulation, no thrombotic complications within the circuit were noted.
Zamora MR, Warner ML, Tuder R, Schwarz MI. Diffuse alveolar hemorrhage and systemic lupus erythematosus: clinical presentation, histology, survival, and outcome. Medicine 1997;76:192–202.
Extracorporeal Life Support Organization. ELSO guidelines for cardiopulmonary extracorporeal life support. Version 1.3. Ann Arbor, MI; 2013.
Lara AR, Schwarz MI. Diffuse alveolar hemorrhage. Chest 2010;137:1164–1171.
Abrams D, Agerstrand CL, Biscotti M, Burkart KM, Bacchetta M, Brodie D. Extracorporeal membrane oxygenation in the management of diffuse alveolar hemorrhage. ASAIO J 2015;61:216–218.
Muellenbach RM, Kredel M, Kunze E, Kranke P, Kuestermann J, Brack A, et al. Prolonged heparin-free extracorporeal membrane oxygenation in multiple injured acute respiratory distress syndrome patients with traumatic brain injury. J Trauma Acute Care Surg 2012;72:1444–1447.
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