63: Therapeutic Plasma Exchange During ECMO: Feasibility and Outcomes A Single-Centre Case Series

Background: The concurrent use of therapeutic plasma exchange (PLEX) and extracorporeal membrane oxygenation (ECMO) is uncommon and technically challenging, with limited data on safety and outcomes. PLEX may offer benefit in conditions driven by severe autoimmunity, hyperinflammation, or toxin overdose, which may co-exist with cardiopulmonary failure requiring ECMO. This case series elucidates our single-center experience with PLEX performed during ECMO support. Methods: We retrospectively reviewed all adult patients admitted to our cardiac thoracic intensive care unit in our hospital between December 2023 and June 2025 who underwent both ECMO and PLEX during the same admission. Demographic data, primary diagnoses, ECMO configuration, number and timing of PLEX sessions, and clinical outcomes were collected. Results: Four patients (median age 53 years, range 41–72; two female) underwent concomitant ECMO and PLEX. Indications for PLEX were thyroid storm (n=1), ANCA-associated vasculitis (n=2), and calcium channel blocker overdose (n=1). ECMO modalities included VA (n=2), VV (n=1), and VVA (n=1). PLEX was initiated within 72 hours of ECMO initiation in three patients. Three patients survived to hospital discharge (ANCA vasculitis with diffuse alveolar hemorrhage, Microscopic polyangiitis and CCB overdose), while one patient died from refractory shock (thyroid storm). No PLEX-related complications such as circuit clotting, hemolysis, or access issues were observed. In survivors, clinical and biochemical improvements facilitated ECMO decannulation and recovery. Limitations: This was a retrospective, small case series without a control group; causality between PLEX and outcome cannot be inferred. Conclusion: PLEX during ECMO runs is technically feasible and may provide additional therapeutic benefit in selected patients with autoimmune or toxin-mediated disease. Further prospective studies are warranted to define its role and optimal timing.