FRI0451 Extra-Corporeal Membrane Oxygenation and Diffuse Alveolar Haemorrhage - A Single Centre CASE Series and Analysis of the ELSO Database. (10th June 2014)

• Record Type: Journal Article
• Authors: Ling, C.Y.; Simpson, T.; Glover, G.; Nicholas, B.; D'Cruz, D.
• Is Part Of: Annals of the rheumatic diseases. Volume 73:Supplement 2(2014)
• Page Start: 550
• Page End: 551
• Publication Date: 2014-06-10
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2014-eular.4191
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: Diffuse alveolar haemorrhage (DAH) is a rare and potentially fatal complication of the systemic vasculitides 1 . DAH may present as a severe acute respiratory distress syndrome (ARDS) with reported mortality of 12- 60% 1. Whilst extracorporeal membrane oxygenation (ECMO) improves outcomes in ARDS 2, use of ECMO in DAH may be considered to be relatively contraindicated due to the requirement for systemic anticoagulation. Methods: A case series of 4 patients with DAH due to ANCA vasculitides diagnosed and or managed by a standardised diagnostic pathway and ARDS treatment algorithm in a single, UK SRF centre, between 2012-13. Analysis of the Extracorporeal Life Support Organisation (ELSO) database using ICD-9 codes 446.2, 446.21, 446.4, 446.6 to report the current international experience of DAH and ECMO 3 . Results: 4 patients with ARDS due to systemic vasculitides were referred via the SRF pathway, but only 3 patients required ECMO (range 120 – 208 hours). 1 patient received a normal protocol heparin regime to target an APTTr of 1.5-2 whilst two patients had 48 hours of ECMO with no heparin followed by low-dose heparin. ICU survival and six months survival were 100% and there were no exacerbations of pulmonary haemorrhage and no clotting complications. The ELSO database contains 78 patients (adult, 59; paediatric, 19) with pulmonary vasculitides who received ECMO. 43 had GPA, whereas the remaining diagnoses included hypersensitivity angiitis, Goodpasture's syndrome and thrombotic microangiopathy. The median age was 23 years old (IQR: 16-47). The median duration of ECMO was 190 hours (IQR: 146-282) and ICU survival was 82%. Twelve patients (15%) were reported to have thrombotic ECMO circuit complications in the context of likely conservative heparinisation. Conclusions: In this case series, ECMO offers an excellent survival rate and clinical outcomes in SRF due to ANCA-associated DAH. ELSO data supports our case series and suggests that DAH related to vasculitides should not be considered a contraindication. ECMO should be considered as supportive therapy in DAH patients with SRF not responsive to conventional therapy. References: Sugimoto T et al. Pulmonary-renal syndrome, diffuse pulmonary haemorrhage and glomerulonephritis, associated with Wegener's granulomatosis effectively treated with early plasma exchange therapy. Intern Med 2007;46:49-53. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 2009;374:1351-63. ECMO Registry of the Extracorporeal Life Support Organization (ELSO), Ann Arbor, Michigan, June (2013). Disclosure of Interest: None declared DOI: 10.1136/annrheumdis-2014-eular.4191