Abciximab-induced alveolar hemorrhage treated with rescue extracorporeal membranous oxygenation.
We describe a case of a 75-year-old woman presenting emergently with an anterior S-T elevation myocardial infarction that deteriorated into ventricular fibrillation requiring prompt resuscitation, resulting in cardiogenic shock. Emergency primary percutaneous coronary intervention of the left anterior descending coronary artery with adjunctive abciximab and heparin resulted in adequate coronary flow, and intra-aortic balloon pump was used to support hemodynamics. Within one hour of intervention, she developed acute respiratory distress with four-quadrant opacification of lung fields, difficulty with oxygenation, and hypotension. Emergency bronchoscopy revealed diffuse erythematous proximal airways with bloody secretions bilaterally confirming diffuse alveolar hemorrhage. An emergency veno-arterial extracorporeal membranous oxygenation (ECMO) circuit was placed at the bedside, acutely improving oxygenation and hemodynamics. She survived the hospitalization with multiple complications related to access site and prolonged intensive care unit stay, was discharged to acute rehabilitation. She is currently thriving 18 months post-procedure. This case highlights the use of ECMO in the often-fatal condition of diffuse alveolar hemorrhage related to glycoprotein inhibitor use.
Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Andrew W
AW
Choi
John E A
JE
Blair
James D
JD
Flaherty
D000077284:Abciximab; D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006469:Hemoptysis / Q000139:chemically induced* / Q000628:therapy; D006489:Hemostatic Techniques; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000009:adverse effects* / Q000627:therapeutic use; D009203:Myocardial Infarction / Q000628:therapy; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D011650:Pulmonary Alveoli
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077284:Abciximab
ECMO; STEMI; alveolar hemorrhage; cardiogenic shock; coronary artery disease; primary PCI