Extracorporeal membrane oxygenation for acute lung injury in idiopathic inflammatory myopathies-a potential lifesaving intervention

Abstract

Objectives: Idiopathic inflammatory myopathies (IIM) can present with acute IIM-related lung injury and respiratory failure, leading to a high mortality risk in intensive care units (ICU). Extracorporeal membrane oxygenation (ECMO) in acute respiratory distress syndrome can be lifesaving. We aimed to report a case series of IIM patients that received ECMO.

Methods: Patients with IIM from tertiary care centres in Belgium, Canada, Denmark, USA and Sweden who underwent ECMO were reviewed to describe clinical characteristics, disease outcomes and hospitalization course. Clinical characteristics at admission and during ICU stay including ECMO complications and mortality causes were summarized.

Results: The study included 22 patients (50% female, mean ± SD age at admission 47 ± 12 years) with anti-MDA5 positive dermatomyositis (68%), anti-synthetase syndrome (14%), polymyositis (9%), overlap myositis (5%) and non-MDA5 dermatomyositis (5%). Patients had low comorbidity scores and 46% had received immunosuppression before their ICU admission. Eight (36%) patients died in the ICU, six (27%) were bridged to recovery and eight (36%) were bridged to transplant. When comparing patients bridged to recovery and those who died in the ICU, those who died were older (P = 0.03) and had higher median Charlson comorbidity index scores (P = 0.05). Both groups had similar frequencies of ECMO-related complications (33% vs 50%, P = 0.94).

Conclusion: In the patients exposed to ECMO in this case series, 14 were successfully bridged to recovery or transplant, while 8 died in the ICU. Large studies are needed to collect data on clinical outcomes in patients with IIM-ILD exposed to ECMO to identify the best candidates for the intervention.

Keywords: anti-MDA5 antibody; dermatomyositis; extracorporeal membrane oxygenation; lung transplantation; rapid progressive interstitial lung disease.