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The use of ECMO in pediatric granulomatosis with polyangiitis
Rachel Finkel1, Jesse Honig2, Chun P Chao3
1Department of Pediatrics, Maria Fareri Children's Hospital, Westchester Medical Center, New York Medical College, Valhalla, New York, USA.
Insights
Extracorporeal membrane oxygenation (ECMO) can support children with severe pulmonary hemorrhage from Granulomatosis with Polyangiitis (GPA) vasculitis. This life-saving therapy, combined with other treatments, offers hope for pediatric patients with this rare condition.
Area of Science:
- Pediatric Rheumatology
- Critical Care Medicine
- Nephrology
Background:
- Granulomatosis with Polyangiitis (GPA) is a rare vasculitis in children, often presenting with severe pulmonary and renal involvement.
- Pediatric GPA vasculitis carries a high mortality rate, necessitating aggressive treatment strategies.
Observation:
- A 13-year-old male with newly diagnosed GPA experienced life-threatening pulmonary hemorrhage.
- The patient required intensive multi-organ support, including extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT).
Findings:
- Successful management involved a combination of ECMO, CRRT, plasmapheresis, rituximab, cyclophosphamide, and corticosteroids.
- ECMO provided crucial hemodynamic and respiratory support, enabling the administration of other vital therapies.
Implications:
- This case highlights the potential of ECMO as a life-sustaining bridge therapy in pediatric patients with severe pulmonary hemorrhage due to GPA.
- Aggressive, multi-modal treatment including ECMO may improve outcomes for children with this critical condition.
Background:
Granulomatosis with polyangiitis (GPA) vasculitis with pulmonary-renal syndrome rarely presents in children and is associated with high mortality rates.
Case Presentation:
We present the case of a 13-year-old male with newly diagnosed GPA vasculitis, treated with extracorporeal membrane oxygenation, continuous renal replacement therapy, plasmapheresis, rituximab, cyclophosphamide, and corticosteroids.
Conclusion:
This case presentation demonstrates that ECMO can be used as a life supporting therapy in pediatric patients with pulmonary hemorrhage from ANCA vasculitis in conjunction with other therapies.
