Veno-Venous Extracorporeal Membrane Oxygenation with Long-Distance Patient Transport for Severe Acute Hypoxemic Respiratory Failure and Diffuse Alveolar Hemorrhage Secondary to Granulomatosis with Polyangitis

Introduction: Diffuse alveolar hemorrhage (DAH) is an early pulmonary complication of hematopoietic cell transplantation (HCT) associated with severe hypoxemic respiratory failure and mortality. Extracorporeal membrane oxygenation (ECMO) support is often used for respiratory failure refractory to conventional interventions; however, its use has been limited in HCT patients with DAH due to potential for worsening alveolar hemorrhage and reported high mortality.Case Presentation: We report two cases of DAH following HCT who developed refractory hypoxemic respiratory failure despite cessation of bleeding and were successfully supported with ECMO.Conclusion: DAH after HCT should not automatically preclude ECMO support; rather, these patients must be evaluated individually for ECMO within the context of their overall clinical picture.

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Extracorporeal membrane oxygenation for diffuse alveolar hemorrhage and severe hypoxemic respiratory failure from silicone embolism

Perfusion ◽

10.1177/0267659110375327 ◽

2010 ◽

Vol 25 (4) ◽

pp. 249-252 ◽

Cited By ~ 12

Author(s):

LB Mongero ◽

D. Brodie ◽

J. Cunningham ◽

C. Ventetuolo ◽

H. Kim ◽

...

Keyword(s):

Respiratory Failure ◽

Extracorporeal Membrane Oxygenation ◽

Pulmonary Hemorrhage ◽

Diffuse Alveolar Hemorrhage ◽

Ecmo Support ◽

Alveolar Hemorrhage ◽

Inert Material ◽

Hypoxemic Respiratory Failure ◽

Membrane Oxygenation ◽

Embolism Syndrome

Liquid silicone is an inert material that may be used for cosmetic procedures by physicians as well as illegally by non-medical personnel. The use of silicone may result in severe complications, disfigurement, and even death. In addition, the indications for extracorporeal membrane oxygenation (ECMO) support have been increasing as a salvage therapy for a variety of life-threatening conditions. The patient is a 27-year-old woman with no significant medical conditions who developed silicone emboli, and subsequent diffuse alveolar hemorrhage after being injected with silicone in her gluteal region without medical supervision. She became profoundly hypoxemic and suffered a brief asystolic cardiac arrest in this setting. The patient was placed on veno-venous ECMO support for 14 days. Medical care during ECMO was complicated by pulmonary hemorrhage, hemothorax, pneumothorax, and blood clot, resulting in oxygenator change-out. A modified adult ECMO circuit (Jostra QuadroxD, Maquet Cardiopulmonary, Rastatt, Germany) was used to transport the patient from a nearby community affiliate hospital and then reconfigured for the medical intensive care unit on a standard HL-20 heart-lung console. Although the use of ECMO for severe hypoxemic respiratory failure has been widely reported, to our knowledge, this is the first reported successful use of ECMO for silicone embolism syndrome associated with diffuse alveolar hemorrhage and severe hypoxemic respiratory failure.

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Extracorporeal Membrane Oxygenation in Acute Hypoxemic Respiratory Failure: Current Status in India

Critical Care Update 2017 ◽

10.5005/jp/books/13063_23 ◽

2018 ◽

pp. 134-134

Author(s):

Sandeep Dewan ◽

Munish Chauhan ◽

Madhur Arora

Keyword(s):

Respiratory Failure ◽

Extracorporeal Membrane Oxygenation ◽

Current Status ◽

Hypoxemic Respiratory Failure ◽

Acute Hypoxemic Respiratory Failure ◽

Membrane Oxygenation

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Inhaled nitric oxide mitigates need for extracorporeal membrane oxygenation in a patient with refractory acute hypoxemic respiratory failure due to cardiac and pulmonary shunts

Respiratory Medicine Case Reports ◽

10.1016/j.rmcr.2018.03.017 ◽

2018 ◽

Vol 24 ◽

pp. 98-102

Author(s):

Brandon Nokes ◽

Beeletsega Yeneneh ◽

Jake Maddux ◽

Ryan C. Van Woerkom ◽

Amelia Lowell ◽

...

Keyword(s):

Nitric Oxide ◽

Respiratory Failure ◽

Extracorporeal Membrane Oxygenation ◽

Inhaled Nitric Oxide ◽

Hypoxemic Respiratory Failure ◽

Acute Hypoxemic Respiratory Failure ◽

Membrane Oxygenation

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The Evaluation of Extracorporeal Membrane Oxygenation in Children with Acute Hypoxemic Respiratory Failure in China: A Five-year Single-center Retrospective Study

10.21203/rs.3.rs-319038/v1 ◽

2021 ◽

Author(s):

Jiayun Ying ◽

Ye Cheng ◽

Gangfeng Yan ◽

Guoping Lu ◽

Weiming Chen ◽

...

Keyword(s):

Retrospective Study ◽

Respiratory Failure ◽

Extracorporeal Membrane Oxygenation ◽

Rescue Therapy ◽

Vital Signs ◽

Data Entry ◽

Hypoxemic Respiratory Failure ◽

Acute Hypoxemic Respiratory Failure ◽

Laboratory Findings ◽

Membrane Oxygenation

Abstract Objective: To summarize the clinical features, laboratory parameters, and outcomes of children with acute hypoxemic respiratory failure supported by extracorporeal membrane oxygenation and explore the risk factors of the prognosis.Methods: It’s a retrospective study from one hospital the Pediatric Intensive Care Unit of Children’s Hospital of Fudan University in China. Patients, aged 28 days to 18 years, with acute hypoxemic respiratory failure supported by mechanical ventilation underwent extracorporeal membrane oxygenation from January 2015 to December 2019 were enrolled in this study. The primary outcome was defined as in-hospital mortality within 28 d after admission. Demographics, medical history, comorbidities, laboratory findings, vital signs, medications, need for continuous renal replacement therapy, need for other rescue therapy, need for transportation, ventilator settings, oxygenation indices were recoded. Appropriate data entry and statistical analysis were performed on access 2007 and SPSS software version 23.Results: Fifty patients with severe acute hypoxemic respiratory failure were enrolled in the study. We analyzed 45 patients (90%) after excluding 5 for missing data. Overall mortality was 53.5%. The PaO2 prior to extracorporeal membrane oxygenation was higher (64 cmH2O [51.9, 70.0 cmH2O] vs 55.1 cmH2O [43.8,60.1], p = 0.009) and OI prior to extracorporeal membrane oxygenation was lower (33.3 [30.1, 40.7] vs 41.2 [33.2 -55.1], p = 0.031) in survivors than nonsurvivors. In multivariate analysis, PaO2 prior to extracorporeal membrane oxygenation was significantly associated with survival (odds ratio 1.129, 95% Cl 1.022 -1.247).Conclusions: Extracorporeal membrane oxygenation might be an alternative strategy for pediatric patients with severe acute hypoxemic respiratory failure Low PaO2 prior to extracorporeal membrane oxygenation indicated a poor prognosis. Maybe we should consider that extracorporeal membrane oxygenation should be implemented earlier.Trial registration: This study was registered on the Clinical Trail. The number is NCT04709432.

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