Background and Goal of Study: Vasculitis is one of most common causes of acute, life-threatening, diffuse alveolar haemorrhage1. The survival rate in those patients who are ventilated because of pulmonary vasculitis is 24% in some studies and remains unchanged in this group despite the introduction of rituximab and plasmapheresis1. We aimed to review survival rate of patients supported with ECMO in the context of vasculitis-induced respiratory failure.

Materials and Methods: We performed a retrospective, single-center observational review of patients admitted between December 2011 and March 2017 and supported with ECMO while presenting with one of the diagnoses listed in the 2012 Nomenclature of Vasculitides. Aside from standard demographics, we recorded survival rate until discharge from ICU and 180-day after discharge and measured the change in compliance and PaO2/FiO2 ratio throughout the period they were supported with ECMO. Diagnoses were confirmed by the detection of the relevant antibodies. 

Results and Discussion: We identified five patients. Mean time of treatment in ICU was 19 days. Apart from standard treatment with steroids, antibiotics and antifungals two patients were treated with rituximab and plasmapheresis. The average time on ECMO support was 14 days. Survival rate until discharge as well as 180-day survival rate was 100%. There was a mean increase in compliance of 2,36 and mean increase in PFR of 4,5 throughout ECMO support. Among complications, there were 2 cases of cardiac arrest during treatment, both successfully resuscitated. In comparison, we calculated survival rate in general respiratory ECMO population from the studied period, and found, that 72 % of those patients survived until discharge from ICU, and 180-day survival rate was 65%.  

Conclusion(s): ECMO is a promising supportive therapy in patients with acute pulmonary deteriorations of vasculitis. ECMO may increase chances of survival as well as chances of functional recovery of lungs in this group of patients. To our knowledge, this is the largest case-series analysis of adults supported with respiratory ECMO, who were diagnosed with severe respiratory failure caused by vasculitis.

References (optional): 

1.Quadrelli S, Dubinsky D, Solis M et al. Immune diffuse alveolar hemorrhage: Clinical presentation and outcome. Respir Med. 2017 Aug;129:59-62.

Acknowledgements (optional): This research was conducted thanks to 2016 ESA trainee exchange programme.

02 / Retrospective, single-center case-series analysis of respiratory ECMO for life-threatening presentations of vasculitis.