Extracorporeal Membrane Oxygenation in Massive Pulmonary Hemorrhage Secondary to Arteriovenous Malformation

We report a case of a 63-year-old man with severe pulmonary hemorrhage secondary to arteriovenous malformation and ventilatory failure due to reduced alveolar diffusion and airway obstruction. Bronchoscopy revealed high-flow active bleeding and clots obstructing the orotracheal tube and bronchial tree, refractory to local therapeutic measures. The patient was successfully supported with venovenous extracorporeal membrane oxygenation (ECMO) without systemic anticoagulation for 12 days as a bridge to definitive therapy. During this period, two angiographic arterial embolization attempts were unsuccessful, ultimately necessitating a right lower pulmonary lobectomy. In cases of massive hemoptysis, maintenance of airway patency and bleeding control should be carried out simultaneously. Treatment often includes bronchoscopy, angiographic arterial embolization, and, in the case of refractory bleeding, surgery. Venovenous ECMO provides short-term stabilization in pulmonary hemorrhage with refractory hypoxemic respiratory failure that is limiting a definitive intervention to achieve hemostasis.