Oxygenator failure in acute myeloid leukaemia. A case report

Abstract

Extracorporeal membrane oxygenation (ECMO) therapy can be used to rescue patients who develop respiratory failure with acute myeloid leukaemia. We describe a unique case of rapid failure of an oxygenator on ECMO, secondary to high leukocyte count and cell lysis in an adult patient with acute myeloid leukaemia.

Outcomes of pediatric patients with oncologic disease or following hematopoietic stem cell transplant supported on extracorporeal membrane oxygenation: The PEDECOR experience

“…10,30,31 Whether bleeding complications in oncologic and/or HSCT patients on ECMO are more frequent is still controversial. 13,38,39,43 In this cohort, bleeding complications were similar comparing cases versus controls, although mean platelet counts were significantly lower, and the daily volumes of platelets transfused were significantly higher in ECMO patients with oncologic disease and/or HSCT compared with controls. 13,41,48,49 and duration of ICU admission prior to intubation.…”

“…The underlying disease and sequelae of treatment can predispose patients with oncologic disease and/or HSCT to all these complications: bleeding and clotting due to thrombocytopenia and impaired hepatic function 38‐40 ; infectious complications due to neutropenia, lymphopenia and immunosuppressive medications 36,41 ; fluid overload and acute kidney injury due to renal impairment 41,42 ; and respiratory compromise due to pulmonary dysfunction 10,30,31 . Whether bleeding complications in oncologic and/or HSCT patients on ECMO are more frequent is still controversial 13,38,39,43 . In this cohort, bleeding complications were similar comparing cases versus controls, although mean platelet counts were significantly lower, and the daily volumes of platelets transfused were significantly higher in ECMO patients with oncologic disease and/or HSCT compared with controls.…”

“…The most common complications on ECMO include bleeding and clotting, renal failure requiring RRT, infectious complications, circuit‐related dysfunction, and central nervous system complications 24,35‐37 38‐40 ; infectious complications due to neutropenia, lymphopenia and immunosuppressive medications 36,41 ; fluid overload and acute kidney injury due to renal impairment 41,42 ; and respiratory compromise due to pulmonary dysfunction 10,30,31 . Whether bleeding complications in oncologic and/or HSCT patients on ECMO are more frequent is still controversial 13,38,39,43 .…”

“…13,14 The eight patients after HSCT represented a complications. 24,[35][36][37] The underlying disease and sequelae of treatment can predispose patients with oncologic disease and/or HSCT to all these complications: bleeding and clotting due to thrombocytopenia and impaired hepatic function [38][39][40] ; infectious complications due to neutropenia, lymphopenia and immunosuppressive medications 36,41 ; fluid overload and acute kidney injury due to renal impairment 41,42 ; and respiratory compromise due to pulmonary dysfunction. 10,30,31 Whether bleeding complications in oncologic and/or HSCT patients on ECMO are more frequent is still controversial.…”

Extracorporeal membrane oxygenation simulation-based training: methods, drawbacks and a novel solution

“…Incorrect cues: the emergency is characterized by the rise of trans-membrane pressure.Missing cues: visible clots on the membrane, no blood color change representing hypoxemia, unrealistic blood parameters (blood gases, hematocrit, hemoglobin and activated clotting time) on modern ECMO consoles (e.g. CardioHelp) or inline monitors.Contextual authenticity: rapid oxygenator failure is extremely rare 46. Clots typically build up and, hence, a more realistic scenario would start with indicators of oxygenator failure, such as low oxygenation efficiency and high trans-membrane pressure that are not sufficient to trigger alarms, but still indicate potential failure.…”