Comparison of the use of venovenous extracorporeal membrane oxygenation in anti-melanoma differentiation-associated protein 5 positive dermatomyositis and other systemic rheumatic diseases associated with acute respiratory failure based on a single-center retrospective study

Lifeng Wang; Xueling Wu; Shuangjun He; Xiaodong Wang; Weijun Wang; Yi Chen; Cuiying Xie

doi:10.21037/jtd-24-650

Comparison of the use of venovenous extracorporeal membrane oxygenation in anti-melanoma differentiation-associated protein 5 positive dermatomyositis and other systemic rheumatic diseases associated with acute respiratory failure based on a single-center retrospective study

J Thorac Dis. 2024 Oct 31;16(10):6516-6524. doi: 10.21037/jtd-24-650. Epub 2024 Oct 30.

Authors

Lifeng Wang^#¹, Xueling Wu^#², Shuangjun He¹, Xiaodong Wang³, Weijun Wang⁴, Yi Chen¹, Cuiying Xie¹

Affiliations

¹ Department of Emergency, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
² Department of Pulmonology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
³ Department of Rheumatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
⁴ Department of Cardiovascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.

^# Contributed equally.

Abstract

Background: Systemic rheumatic diseases (SRDs), particularly anti-melanoma differentiation-associated protein 5 positive dermatomyositis (MDA5⁺ DM), often affect the respiratory system and have a predisposition for developing into acute respiratory failure (ARF). Venovenous extracorporeal membrane oxygenation (VV-ECMO) can provide full respiratory support and can be used as a life-saving intervention. The present study describes the clinical profiles and prognoses of patients with MDA5⁺ DM and other SRDs receiving VV-ECMO for ARF.

Methods: A single-center retrospective study of patients with SRD who received VV-ECMO between June 2017 and February 2022 was conducted. Demographic and laboratory data, treatments, extracorporeal membrane oxygenation (ECMO) parameters, and clinical outcomes were extracted from electronic medical records and compared between patients with MDA5⁺ DM and other SRDs.

Results: Seven patients with MDA5⁺ DM and four patients with other SRDs were included in the study. Treatment by ECMO was provided for 152 days. Only one patient experienced ECMO-related complications. Three patients in the other SRD group survived to ECMO decannulation, and two of these patients survived to discharge. However, no patients in the MDA5⁺ DM group survived to decannulation or discharge.

Conclusions: Treatment by VV-ECMO could be safely applied to patients with SRDs to maintain normal respiration and oxygenation. However, patients with MDA5⁺ DM associated with ARF who underwent VV-ECMO had worse outcomes.

Keywords: Venovenous extracorporeal membrane oxygenation (VV-ECMO); acute respiratory failure (ARF); anti-melanoma differentiation-associated protein 5 positive dermatomyositis (MDA5+ DM); systemic rheumatic diseases (SRDs).