Indian Journal of Critical Care Medicine

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VOLUME 24 , ISSUE 9 ( September, 2020 ) > List of Articles

CASE REPORT

A Case of Refractory Hypoxemic Respiratory Failure due to Antineutrophil Cytoplasmic Antibodies-associated Diffuse Alveolar Hemorrhage Rescued by Extracorporeal Membrane Oxygenation

Manoj K. Goel, Munish Chauhan, Pooja Wadwa, Gargi Maitra, Milind Talegaonkkar, Sandeep Dewan

Keywords : Antineutrophil cytoplasmic antibodies-associated vasculitis, Diffuse alveolar hemorrhage, Extracorporeal membrane oxygenation

Citation Information : Goel MK, Chauhan M, Wadwa P, Maitra G, Talegaonkkar M, Dewan S. A Case of Refractory Hypoxemic Respiratory Failure due to Antineutrophil Cytoplasmic Antibodies-associated Diffuse Alveolar Hemorrhage Rescued by Extracorporeal Membrane Oxygenation. Indian J Crit Care Med 2020; 24 (9):879-881.

DOI: 10.5005/jp-journals-10071-23585

License: CC BY-NC 4.0

Published Online: 17-10-2020

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Diffuse alveolar hemorrhage (DAH) is a rare but life-threatening disease. Mortality is very high in those patients who require mechanical ventilation. Traditionally, active bleeding has been considered a contraindication for extracorporeal membrane oxygenation (ECMO) support. There is limited evidence for ECMO in DAH as rescue therapy. Herein, we describe a case of antineutrophil cytoplasmic antibodies-associated DAH with intractable hypoxemic respiratory failure. An appropriate ventilator strategy failed to improve her hypoxemia leading to imminent risk to her life. The patient was rescued with veno-venous ECMO targeting lower than usual range of anticoagulation. ECMO proved to be lifesaving in our patient who was initiated on prompt immunosuppressive therapy and plasmapheresis along with continuous veno-venous hemodiafiltration and hemodynamic support. We feel that ECMO could be considered as adjunctive therapy in severe hypoxemic respiratory failure associated with DAH after careful consideration of the risk of bleeding and a restrictive anticoagulation strategy.


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