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Extracorporeal membrane oxygenation in the management of granulomatosis with polyangiitis
Author(s) -
Yin Kanhua,
March Robert J.,
Hoopes Charles W.,
Balk Robert A.,
Raman Jaishankar,
Lateef Omar B.,
Tiwari Ankur,
Bak Erica,
Karlson Karl J.,
Edwards Niloo M.,
Dobrilovic Nikola
Publication year - 2021
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.15252
Subject(s) - medicine , interquartile range , extracorporeal membrane oxygenation , diffuse alveolar hemorrhage , granulomatosis with polyangiitis , microscopic polyangiitis , respiratory failure , surgery , vasculitis , disease
Granulomatosis with polyangiitis (GPA, also known as Wegener's granulomatosis) is a type of systematic vasculitis that primarily involves the lung and kidney. Diffuse alveolar hemorrhage (DAH) and associated acute respiratory failure are uncommon but devastating complications of GPA. Experience in using extracorporeal membrane oxygenation (ECMO) to manage DAH caused by GPA is limited. We report two GPA patients with DAH that were successfully managed using ECMO support. Examining 13 cases identified in the literature and two of our own, we observed that most patients experienced rapid deterioration in respiratory function in conjunction with a precedent respiratory infection. All 15 patients received veno‐venous ECMO support. The median duration of ECMO support was 11 days (interquartile range: 7.5–20.75 days). Bleeding was the most common complication, seen in four (26.7%) cases. All patients were successfully weaned off ECMO after a median length of hospital stay of 42 days (interquartile range: 30–78 days). We demonstrated that the use of ECMO is a reasonable and effective support option in the management of GPA patients with DAH. The risk of bleeding is high but maybe reduced using a lower anticoagulation goal.