Extracorporeal Membrane Oxygenation in Patients With Pulmonary Hemorrhage

Severe pulmonary hemorrhage may lead to refractory hypoxemia and/or hemodynamic collapse and cause high mortality. However, the use of extracorporeal membrane oxygenation (ECMO) in this patient population is rare. The aim of this study is to better define and understand this patient population by exploring the baseline characteristics, complications, and outcomes of patients who receive ECMO support due to pulmonary hemorrhage, based on data extracted from the extracorporeal life support organization (ELSO) registry. Between 2003 and 2023, 96 patients received ECMO due to pulmonary hemorrhage. Complications occurred in 54% of the patients, mainly acute kidney injury (AKI) with need for renal replacement therapy (RRT; 28%) and bleeding (pulmonary, gastrointestinal) (15%). Respiratory infections occurred in 37.1% of the patients. The most common diagnostic/therapeutic procedures were computed tomography scans in 9%, bronchoscopy in 41%, surgery in 8%, and apheresis in 6% of the patients. Interventional radiology procedures were performed in only 2% of the patients. Interpretation of these data should be performed cautiously, as underreporting is a known limitation of the ELSO Registry. Forty-seven patients (49%) were weaned from ECMO, and 46 (48%) survived until discharge. Survival and complication rates are comparable to the overall ECMO cohort in the ELSO Registry, which makes ECMO a feasible strategy in this patient population.