医学
体外膜肺氧合
显微镜下多血管炎
肺出血
肉芽肿伴多发性血管炎
弥漫性肺泡出血
血管炎
抗中性粒细胞胞浆抗体
体外心肺复苏
心肺复苏术
回顾性队列研究
内科学
肺
外科
复苏
疾病
作者
Erika R OʼNeil,Rachel E. Quinn,Taylor Olson,Peter Rycus,Marc Anders,Corey Chartan,Tiphanie P. Vogel,Manuel Silva‐Carmona,Ryan Coleman
出处
期刊:Asaio Journal
[Ovid Technologies (Wolters Kluwer)]
日期:2021-07-27
卷期号:68 (4): 553-560
被引量:1
标识
DOI:10.1097/mat.0000000000001539
摘要
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides with pulmonary involvement include granulomatosis with polyangiitis, microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis, and can present with life-threatening pulmonary hemorrhage in up to 40% of patients. Mortality in those patients who require intubation and mechanical ventilation can reach 77%. Extracorporeal membrane oxygenation (ECMO) can be used to support these patients through definitive diagnosis and treatment, although minimizing the risk of ventilator-induced lung injury. We aimed to determine factors associated with favorable outcomes in patients with (ANCA)-associated vasculitides supported on ECMO. We performed a retrospective observational study using the Extracorporeal Life Support Organization registry of pediatric and adult patients with ANCA-associated vasculitis supported on ECMO from 2010 to 2020. One hundred thirty-five patients were included for analysis. Many patients had renal involvement (39%) in addition to pulmonary involvement (93%). Survival was 73% in AAV patients supported on ECMO. The presence of pulmonary hemorrhage was not associated with worse outcomes in our cohort. Older age, the use of venoarterial ECMO, ECMO-cardiopulmonary resuscitation, or sustaining a cardiac arrest before ECMO was associated with decreased survival. In conclusion, venovenous ECMO should be considered as a supportive bridge to definitive diagnosis and treatment in (ANCA)-associated vasculitides, regardless if pulmonary hemorrhage is present.
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