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

Wolfgang Hohenforst-Schmidt1 II Medical Clinic, Coburg Clinic, University of Wuerzburg, Coburg, Germany

Arndt Petermann2 Division of Nephrology, Coburg Clinic, University of Wuerzburg, Coburg, Germany

Aikaterini Visouli3 Cardiothoracic Surgery Department, “Saint Luke” Private Hospital, Thessaloniki, Greece

Paul Zarogoulidis4 Pulmonary Department, “G Papanikolaou” General Hospital, Aristotle University of Thessaloniki, Thessaloniki, GreeceCorrespondence[email protected]

Kaid Darwiche5 Department of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital, University of Duisburg-Essen, Essen, Germany

Ioanna Kougioumtzi6 Surgery Department (National Health System), University General Hospital of Alexandroupolis, Alexandroupolis, Greece

Kosmas Tsakiridis3 Cardiothoracic Surgery Department, “Saint Luke” Private Hospital, Thessaloniki, Greece

Nikolaos Machairiotis6 Surgery Department (National Health System), University General Hospital of Alexandroupolis, Alexandroupolis, Greece

Markus Ketteler2 Division of Nephrology, Coburg Clinic, University of Wuerzburg, Coburg, Germany

Konstantinos Zarogoulidis4 Pulmonary Department, “G Papanikolaou” General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

Johannes Brachmann1 II Medical Clinic, Coburg Clinic, University of Wuerzburg, Coburg, Germany

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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.

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The authors report no conflicts of interest in this work.

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

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

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