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Extracorporeal membrane oxygenation for Life-threatening ANCA-positive pulmonary capillaritis. A review of UK experience.

Yusuff H, Malagon I, Robson K, Parmar J, Hamilton P, Falter F - Heart Lung Vessel (2015)

Bottom Line: Clinical improvement was achieved without exacerbation of the pulmonary hemorrhage despite the use of anticoagulants.This provided time for the immunosuppressants to take effect.Both patients were discharged and were cured of the underlying condition.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiothoracic Intensive Care, Papworth Hospital, Cambridge, UK.

ABSTRACT

Introduction: Anti-neutrophil cytoplasmic antibody positive pulmonary capillaritis complicated by diffuse alveolar hemorrhage is a potentially fatal condition for which extracorporeal membrane oxygenation can facilitate improved outcomes and potential cure. Diffuse alveolar hemorrhage can be the initial presentation of an autoimmune disorder. The management is centered on the use of immunosuppressive therapy, which requires time, with fatality often occurring for these patients. We showed two very young patients with no previous history of vasculitis presenting with life threatening pulmonary hemorrhage due to anti-neutrophil cytoplasmic antibody positive vasculitis, whose management was facilitated with extracorporeal membrane oxygenation.

Methods: We reviewed the clinical presentation and course of the first two patients with diffuse alveolar hemorrhage for anti-neutrophil cytoplasmic antibody positive vasculitis managed with veno-venous extracorporeal membrane oxygenation. We highlighted and analysed the unique challenges encountered in managing these patients.

Results: The two patients were referred for extracorporeal membrane oxygenation since conventional ventilation was inadequate to provide physiologic support for respiratory failure. Clinical improvement was achieved without exacerbation of the pulmonary hemorrhage despite the use of anticoagulants. This provided time for the immunosuppressants to take effect. Both patients were discharged and were cured of the underlying condition.

Conclusions: Extracorporeal membrane oxygenation has a role in the management of patients with severe respiratory failure due to anti-neutrophil cytoplasmic antibody positive capillaritis. Early recognition and referral for extracorporeal membrane oxygenation are vital to achieve a favourable outcome.

No MeSH data available.


Related in: MedlinePlus

Key Points.VV ECMO = veno-venous extracorporeal membrane oxygenation; ANCA = anti-neutrophil cytoplasmic antibody.
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Figure 003: Key Points.VV ECMO = veno-venous extracorporeal membrane oxygenation; ANCA = anti-neutrophil cytoplasmic antibody.


Extracorporeal membrane oxygenation for Life-threatening ANCA-positive pulmonary capillaritis. A review of UK experience.

Yusuff H, Malagon I, Robson K, Parmar J, Hamilton P, Falter F - Heart Lung Vessel (2015)

Key Points.VV ECMO = veno-venous extracorporeal membrane oxygenation; ANCA = anti-neutrophil cytoplasmic antibody.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4476770&req=5

Figure 003: Key Points.VV ECMO = veno-venous extracorporeal membrane oxygenation; ANCA = anti-neutrophil cytoplasmic antibody.
Bottom Line: Clinical improvement was achieved without exacerbation of the pulmonary hemorrhage despite the use of anticoagulants.This provided time for the immunosuppressants to take effect.Both patients were discharged and were cured of the underlying condition.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiothoracic Intensive Care, Papworth Hospital, Cambridge, UK.

ABSTRACT

Introduction: Anti-neutrophil cytoplasmic antibody positive pulmonary capillaritis complicated by diffuse alveolar hemorrhage is a potentially fatal condition for which extracorporeal membrane oxygenation can facilitate improved outcomes and potential cure. Diffuse alveolar hemorrhage can be the initial presentation of an autoimmune disorder. The management is centered on the use of immunosuppressive therapy, which requires time, with fatality often occurring for these patients. We showed two very young patients with no previous history of vasculitis presenting with life threatening pulmonary hemorrhage due to anti-neutrophil cytoplasmic antibody positive vasculitis, whose management was facilitated with extracorporeal membrane oxygenation.

Methods: We reviewed the clinical presentation and course of the first two patients with diffuse alveolar hemorrhage for anti-neutrophil cytoplasmic antibody positive vasculitis managed with veno-venous extracorporeal membrane oxygenation. We highlighted and analysed the unique challenges encountered in managing these patients.

Results: The two patients were referred for extracorporeal membrane oxygenation since conventional ventilation was inadequate to provide physiologic support for respiratory failure. Clinical improvement was achieved without exacerbation of the pulmonary hemorrhage despite the use of anticoagulants. This provided time for the immunosuppressants to take effect. Both patients were discharged and were cured of the underlying condition.

Conclusions: Extracorporeal membrane oxygenation has a role in the management of patients with severe respiratory failure due to anti-neutrophil cytoplasmic antibody positive capillaritis. Early recognition and referral for extracorporeal membrane oxygenation are vital to achieve a favourable outcome.

No MeSH data available.


Related in: MedlinePlus