Key result
ECMO is linked to ~94% survival to discharge in severe autoimmune cardiopulmonary failure.
Why the study?
Systemic autoimmune and vasculitic disorders can cause life-threatening respiratory or cardiac failure requiring temporary ECMO support while disease-directed therapy is initiated. This study synthesized patient-level data to characterize clinical circumstances, ECMO modalities, disease-directed treatments, anticoagulation strategies, complications, and outcomes in these patients.
Does extracorporeal membrane oxygenation (ECMO) combined with disease-directed immunosuppressive therapy support survival to hospital discharge in patients with life-threatening cardiopulmonary manifestations of systemic autoimmune and vasculitic disorders?
Systematic Review (n=33)
Does extracorporeal membrane oxygenation (ECMO) combined with disease-directed immunosuppressive therapy support survival to hospital discharge in patients with life-threatening cardiopulmonary manifestations of systemic autoimmune and vasculitic disorders?
In this patient-level systematic synthesis of 33 patients with life-threatening cardiopulmonary manifestations of systemic autoimmune and vasculitic disorders, temporary ECMO support combined with immunosuppressive therapy was associated with a 93.9% survival to hospital discharge, though findings are limited by publication bias.
Answers are grounded in this paper and cite their sources.
May support ECMO in refractory autoimmune cardiopulmonary failure; hypothesis-generating given publication bias and observational data.
Objective: Systemic autoimmune and vasculitic disorders may cause lifethreatening respiratory or cardiac failure, including diffuse alveolar hemorrhage (DAH), acute respiratory distress syndrome (ARDS), fulminant myocarditis, and cardiogenic shock.Extracorporeal membrane oxygenation (ECMO) may provide temporary cardiopulmonary support while disease-directed therapy is initiated.This patient-level clinical synthesis characterized the clinical circumstances prompting ECMO, the underlying cardiopulmonary manifestations, VVversus VA-ECMO use, disease-directed treatment administered during ECMO support, anticoagulation strategies, ECMO-related complications, and reported outcomes.Methods: PubMed, Embase, Web of Science, and Scopus were searched from inception through 1 August 2026 using combinations of ECMO, systemic autoimmune and vasculitic disorders, and relevant cardiopulmonary manifestations.Reference lists were also screened.Eligible publications were case reports or case series providing sufficient individual-level clinical information.Results: Twenty-seven publications describing 33 patients were included.Mean age was 36.0 ± 16.0 years; 17 (51.5%)were male.DAH with respiratory failure was the predominant manifestation, occurring in 25 patients (75.8%).VV-ECMO was used in 22 patients (66.7%) and VA-ECMO in 11 (33.3%).Median ECMO duration was 192 h (IQR, 120-312 h).ECMO-related complications were reported in 8 patients (24.2%); circuit or oxygenator thrombosis was most frequent (5 [15.2%]).Overall, 31 patients (93.9%) survived to hospital discharge and 2 (6.1%) died.Conclusion: ECMO may provide temporary cardiopulmonary support in carefully selected patients with life-threatening respiratory and/or cardiac failure while disease-directed therapy is administered.However, the reported outcomes should be interpreted cautiously because of publication and reporting bias, clinical heterogeneity, incomplete patient-level information, and the absence of comparative controls.
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Mousa et al. (2026) conducted a systematic review in Systemic autoimmune and vasculitic disorders with life-threatening cardiopulmonary manifestations (n=33). Extracorporeal membrane oxygenation (VV-ECMO or VA-ECMO) was evaluated on Survival to hospital discharge. Extracorporeal membrane oxygenation in 33 patients with life-threatening autoimmune or vasculitic cardiopulmonary failure was associated with a 93.9% survival to hospital discharge.
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