Diffuse alveolar haemorrhage (DAH) is a catastrophic pulmonary complication of systemic lupus erythematosus. It can result in refractory hypoxaemia despite mechanical ventilation. Increasing lung compliance and worsening pulmonary hypertension can potentiate cardiogenic shock from acute right ventricular failure. In such patients with cardiopulmonary collapse, veno-arterial (V-A) ECMO maybe a viable option that can provide the required haemodynamic support. However, the use of V-A ECMO in such patients is limited due to an associated increased risk of bleeding. Our case report describes the successful use of V-A ECMO without the use of systemic anticoagulation in a patient with DAH. Despite the absence of systemic anticoagulation, no thrombotic complications within the circuit were noted.
Learning points:
Diffuse alveolar haemorrhage (DAH) complicating systemic lupus erythematous can present dramatically with sudden cardiopulmonary collapse.Extracorporeal membrane oxygenation (ECMO) can provide temporary haemodynamic support until conventional medical therapy can take effect.Despite the historical increased bleeding risk associated with ECMO, it can be safely used in patients with DAH to provide time for underlying organ recovery.