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

Wolfgang Hohenforst-Schmidt,¹ Arndt Petermann,² Aikaterini Visouli,³ Paul Zarogoulidis,⁴ Kaid Darwiche,⁵ Ioanna Kougioumtzi,⁶ Kosmas Tsakiridis,³ Nikolaos Machairiotis,⁶ Markus Ketteler,² Konstantinos Zarogoulidis,⁴ Johannes Brachmann<sup>1

1</sup>II Medical Clinic, Coburg Clinic, University of Wuerzburg, Coburg, Germany; ²Division of Nephrology, Coburg Clinic, University of Wuerzburg, Coburg, Germany; ³Cardiothoracic Surgery Department, “Saint Luke” Private Hospital, Thessaloniki, Greece; ⁴Pulmonary Department, “G Papanikolaou” General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; ⁵Department of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital, University of Duisburg-Essen, Essen, Germany; ⁶Surgery Department (National Health System), University General Hospital of Alexandroupolis, Alexandroupolis, Greece

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.

Keywords: ECMO, ARDS, polyangiitis, granulomatosis, hemorrhage