Emergency and Critical Care Center, Tokyo Metropolitan Tama Medical Center, Japan.
Intern Med. 2022 Dec 1;61(23):3569-3573. doi: 10.2169/internalmedicine.9472-22. Epub 2022 May 14.
Regarding extracorporeal membrane oxygenation (ECMO) support against hemorrhagic conditions, there seems to be a dilemma when deciding between maintaining the circuit patency by systemic anticoagulation and increasing the risk of bleeding. We herein report two cases of diffuse alveolar hemorrhage (DAH) caused by myeloperoxidase (MPO) anti-neutrophil cytoplasmic autoantibody-associated vasculitis (AAV) successfully treated with venovenous (VV)-ECMO support, both initially started without systemic anticoagulation. Under anticoagulation-free ECMO management, we should consider the shortcomings of frequent circuit exchange and hemorrhagic diathesis related to circuit-induced disseminated intravascular coagulation (DIC).
关于体外膜肺氧合（ECMO）支持对抗出血情况，在通过全身抗凝维持回路通畅和增加出血风险之间似乎存在两难选择。我们在此报告两例由髓过氧化物酶（MPO）抗中性粒细胞胞质自身抗体相关性血管炎（AAV）引起的弥漫性肺泡出血（DAH），均成功接受了静脉-静脉（VV）-ECMO 支持治疗，最初均未进行全身抗凝。在无抗凝 ECMO 管理下，我们应考虑频繁更换回路的缺点和与回路引起的弥散性血管内凝血（DIC）相关的出血倾向。
