The Role of Extracorporeal Membrane Oxygenation in Successful Management of Cardiopulmonary Failure in Catastrophic Antiphospholipid Syndrome
Yash Vaidya, Aqeel Sandhu.
SUNY Upstate Medical University, Syracuse, NY, USA.
OBJECTIVE: To report the use of extracorporeal membrane oxygenation (ECMO) in the management of cardiogenic shock and respiratory failure from catastrophic antiphospholipid syndrome (CAPS).
METHODS: We report a case of a 35-year-old male who was diagnosed with CAPS manifested by severe heart failure from two vessel coronary disease and mitral regurgitation, end-stage renal disease and thrombotic microangiopathy. He was transferred to our institute from another facility and underwent coronary artery bypass grafting with mitral valve replacement. He developed gram negative septicemia and respiratory failure refractory to medical management. He was placed on veno-venous ECMO with subsequent improvement in pulmonary function and discharge in a stable condition to a rehabilitation facility.
RESULTS: CAPS is a rare condition, occurring in less than 1% of patients with antiphospholipid syndrome (APS). Around 30% of patients with CAPS present with cardiac involvement, with valvular regurgitation and coronary artery thrombosis being the most common cardiac manifestations of the hypercoagulable state. However, heart failure leads to more than 20% deaths. Though prognosis has improved with the use of steroids, plasma exchange and immunoglobulins, mortality rates remain high around 33%. We recommend consideration of ECMO in the treatment of refractory cardiac or pulmonary failure for successful treatment of this condition.
CONCLUSIONS: Use of ECMO for the successful treatment of CAPS is extremely rare with only one previously reported case in the literature. ECMO should be considered early in the management of immunocompromised patients with CAPS who develop refractory cardiopulmonary failure.
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