Extracorporeal membrane oxygenation for the management of respiratory failure due to ANCA-associated vasculitis

We present here two patients whose near fatal respiratory distress was caus ed by pulmonary hemorrhage, and who were treated successfully by extracorpo real membrane oxygenation (ECMO). The underlying disease was anti-neutrophi l cytoplasmic antibody (ANCA)-associated systemic vasculitis. They were ini tially treated with methylprednisolone pulse therapy along with cyclophosph amide. However, their respiratory failure progressed with a low PaO2/FiO(2) ratio (<100 mmHg) despite mechanical ventilation, and ECMO was initiated. After several days, the pulmonary hemorrhage subsided, and the patients wer e weaned successfully from ECMO. We suggest that ECMO may be used to manage life-threatening pulmonary hemorrhage in patients suffering from ANCA-asso ciated systemic vasculitis.