Salvage extracorporeal membrane oxygenation in severe pulmonary haemorrhage: A single-center retrospective observational study

IntroductionExtracorporeal membrane oxygenation (ECMO) has emerged as a treatment option for respiratory failure. Evidence supports use of ECMO for severe ARDS. Diffuse alveolar haemorrhage (DAH) involves diffuse bleeding in the alveolar tissue, typically due to autoimmune or coagulatory disturbances. The accumulation of blood in the alveoli impairs gas exchange and creates a functional right-to-left shunt, leading to hypoxaemia. While ECMO is effective in managing severe ARDS, its role and outcomes in patients with severe DAH are not well documented.MethodsWe performed a retrospective analysis of all patients with diffuse alveolar haemorrhage receiving ECMO support at the Saarland University Medical center from 03/2012 to 02/2025.ResultsFrom an electronic database, 15 Patients with DAH receiving ECMO support were identified. Patients with critical hypoxia due to pulmonary haemorrhage were included. The median PaO2/FiO2 right before ECMO-canulation was 53 (41.43; 56.42). Flexible bronchoscopy identified diffuse bleeding as the main cause of respiratory insufficiency. All included patients (mean age 39.9 ± 19.4 years; nine male) received primary veno-venous (V-V) ECMO. The median duration of ECMO-therapy was 15 (9.31; 25.69) days. The mean blood flow was 3.89 L/min (±1.06) with a sweep gas flow of 3.34 L/min (±2.37 L/min) in the first five ECMO-days. Anticoagulation strategy was determined according to clinical presentation. In two patients, no anticoagulation was administered due to fulminant bleeding. The remaining patients received unfractionated heparin at an average dose of 7.43 IE/kg/h (±3.46 IE/kg/h). Median aPTT of the anticoagulated patients was 39.49 s (±11.76). ECMO was successfully removed following respiratory stabilization in 10 patients. Among the 15 patients in total, 5 (33.33%) died.ConclusionFor patients with critical, refractoy pulmonary bleeding, V-V ECMO is a bridge to recovery option.