Extracorporeal membrane oxygenation for diffuse alveolar hemorrhage and severe hypoxemic respiratory failure from silicone embolism

Abstract

Liquid silicone is an inert material that may be used for cosmetic procedures by physicians as well as illegally by non-medical personnel. The use of silicone may result in severe complications, disfigurement, and even death. In addition, the indications for extracorporeal membrane oxygenation (ECMO) support have been increasing as a salvage therapy for a variety of life-threatening conditions. The patient is a 27-year-old woman with no significant medical conditions who developed silicone emboli, and subsequent diffuse alveolar hemorrhage after being injected with silicone in her gluteal region without medical supervision. She became profoundly hypoxemic and suffered a brief asystolic cardiac arrest in this setting. The patient was placed on veno-venous ECMO support for 14 days. Medical care during ECMO was complicated by pulmonary hemorrhage, hemothorax, pneumothorax, and blood clot, resulting in oxygenator change-out. A modified adult ECMO circuit (Jostra QuadroxD, Maquet Cardiopulmonary, Rastatt, Germany) was used to transport the patient from a nearby community affiliate hospital and then reconfigured for the medical intensive care unit on a standard HL-20 heart-lung console. Although the use of ECMO for severe hypoxemic respiratory failure has been widely reported, to our knowledge, this is the first reported successful use of ECMO for silicone embolism syndrome associated with diffuse alveolar hemorrhage and severe hypoxemic respiratory failure.

Systemic Lupus–Induced Diffuse Alveolar Hemorrhage Treated With Extracorporeal Membrane Oxygenation

“…Mongero et al reported a case of liquid silicone-induced alveolar hemorrhage and PEA arrest successfully treated with venovenous ECMO. 31 Reports of DAH due to SLE treated with ECMO are rare. In the pediatric literature, Kolovos and colleagues report a series of 8 cases of pulmonary hemorrhage successfully treated with ECMO.…”

Extracorporeal Membrane Oxygenation for Diffuse Alveolar Hemorrhage Caused by Idiopathic Pulmonary Hemosiderosis: A Case Report and a Review of the Literature

“…In a case of DAH caused by a silicone embolism, the ECMO circuit without systemic anticoagulation had to be changed 36 hours after commencement due to high line pressure and visible clot formation. 27 In our case, ACT, platelet, PT/INR, fibrinogen, and antithrombin targets were set at 150 to 180 seconds, ! 100,000/mm 3 , !…”

Successful application of extracorporeal membrane oxygenation due to pulmonary hemorrhage secondary to granulomatosis with polyangiitis

“…There are case reports of successful ECMO application to adults with refractory life-threatening respiratory failure due to warfarin-exacerbated diffuse alveolar hemorrhage,30 massive pulmonary hemorrhage after lobar lung transplantation,31 massive lung bleeding with airway blood clot obstruction after pulmonary endarterectomy,32,33 pulmonary hemorrhage related with right middle lobe bronchiectasis,34 and diffuse alveolar hemorrhage after silicone embolism 35…”