Extracorporeal membrane oxygenation with plasma exchange in a patient with alveolar haemorrhage secondary to Wegener's granulomatosis

摘要

A 50-year-old woman with asthma presented with a 2-week history of worsening dyspnoea and cough with small volume haemoptysis. She gave a history of vague weakness, dry cough, sinus congestion and joint pains over the preceding 2-year period. Following 2 weeks of oral antibiotics without resolution of symptoms, a chest X-ray and computed tomography scan was performed, which showed right upper lobe consolidation. She was admitted to a rural hospital and commenced on intravenous ceftriaxone and doxycycline. Her condition rapidly deteriorated with increasing dyspnoea and small volume haemoptysis requiring oxygen therapy. A computed tomography pulmonary angiogram revealed progression of consolidation throughout the lobes (Fig. 1). No embolus was identified. She continued to deteriorate over a 48-h period with worsening hypoxia requiring endotracheal intubation and mechanical ventilation. Despite mechanical ventilation she remained too hypoxic to transfer safely on a portable ventilator to a tertiary setting. A medical retrieval team commenced veno-venous extracorporeal membrane oxygenation (v-v BCMO) with peripheral cannulation. She was safely transferred to a tertiary hospital.