O60 Extra-Corporeal Membrane Oxygenation and Diffuse Alveolar Haemorrhage in Systemic Vasculitides: A Single Centre Case Series and Analysis of the Elso Database
Bibliographic record
Abstract
Background: Diffuse alveolar haemorrhage (DAH) is a rare and potentially fatal complication of the systemic vasculitides. DAH may present as a severe acute respiratory distress syndrome (ARDS) with reported mortality of 12– 60%. Whilst a severe respiratory failure (SRF) strategy incorporating extracorporeal membrane oxygenation (ECMO) improves outcomes in ARDS, use of ECMO in DAH may be considered to be relatively contraindicated due to the requirement for systemic anticoagulation. Methods: A case series of four patients with DAH due to underlying ANCA-associated vasculitides diagnosed and/or managed by a standardized diagnostic pathway and ARDS treatment algorithm in a single, UK SRF centre, between 2012 and 2013. Analysis of the Extracorporeal Life Support Organisation (ELSO) database using ICD-9 codes 446.2, 446.21, 446.4, 446.6 to report the current international experience of DAH and ECMO. Results: Four patients with ARDS due to systemic vasculitides were referred via the SRF pathway, but only three patients required ECMO (range 120–208 h). Median lung injury score (LIS) was 3.5. 1 patient received a normal protocol heparin regime to target an APTTr of 1.5–2 while two patients had 48 h of ECMO with no heparin followed by sub- therapeutic low-dose heparin. ICU survival and six months survival were 100% and there were no exacerbations of pulmonary haemorrhage, no new events of extra-pulmonary haemorrhage and no clotting complications (Table 1). The ELSO database contains 78 patients (adult, 59; paediatric, 19) with pulmonary vasculitides who received ECMO. 43 had a diagnosis of granulomatosis with polyangiitis (GPA), whereas the remaining diagnoses included hypersensitivity angiitis, Goodpasture's syndrome and thrombotic microangiopathy. The median age was 23 years (IQR: 16–47). The median duration of ECMO was 190 h (IQR: 146–282) and ICU survival was 82%. Twelve patients (15%) were reported to have thrombotic ECMO circuit complications in the context of likely conservative heparinization.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.004 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".