Application of extracorporeal membrane oxygenation for diffuse alveolar hemorrhage due to Wegener’s Granulomatosis

• Published in: Kardiyovasküler tıp e dergisi Vol. 6; no. 3; pp. 114 - 116
• Main Authors: Altınbaş, Özgür, Gök, Funda, Işık, Mehmet, Tanyeli, Ömer, Dereli, Yüksel, Görmüş, Niyazi
• Format: Journal Article
• Language: English
• Published: Ismir Galenos Yayınevi 24-09-2018; Galenos Publishing House
• Subjects: Case reports; Extracorporeal membrane oxygenation; Hemodialysis; Hemorrhage; Intensive care; Intubation; Mortality; Patients; Respiratory failure; Respiratory therapy; Surgical apparatus & instruments; Ventilators; İstanbul; Türkiye; respiratory failure; xtracorporeal membrane oxygenation; Wegener’s granulomatosis; alveolar hemorrhage
• ISSN: 2147-1924; 2147-1924
• DOI: 10.32596/ejcm.18.00314

Objective: Wegener’s granulomatosis is a systemic vasculitis, characterized by multifocal vascular necrotizing inflammation
and granulomatosis that affects small and medium-sized blood vessels. It is associated with antineutrophil
cytoplasmic autobody and causes alveolar hemorrhage and renal insufficiency leads to high mortality rates. Extracorporeal
membrane oxygenation (ECMO) is a supportive treatment choice for patients with severe respiratory failure.
We present an ECMO application to 64 year-old female patient with acute alveolar hemorrhage and respiratory failure
due to Wegener’s granulomatosis under CPR.
Case Report: A 64 year-old female patient, previously diagnosed with chronic renal failure due to Wegener’s granulomatosis,
admitted to our hospital for routine hemodialysis programme. At the end of the first hour of hemodialysis
a worsening in her general condition occured and she required intubation and mechanical ventilation. Computerized
thorax tomography revealed bilateral intraalveolar hemorrhage. Although proper medical therapy the patient had respiratory
arrest. Despite successful CPR, adequate oxygenation couldn’t be reached, and ECMO treatment was initated.
Clinical, radiological and laboratory findings showed improvement two days after ECMO initation but the patient died
due to multiorgan failure in the fifth day of the therapy.
Conclusion: Diffuse alveolar hemorrhage is a life-threatining complication associated with Wegener’s granulomatosis.
Mechanical ventilator dependent respiratory failure may develop and this process can be mortal. ECMO is a
reasonable management option for such clinical situations.