Extracorporeal membrane oxygenation in adults receiving haematopoietic cell transplantation: an international expert statement

Sepsis and acute respiratory failure in patients with cancer: how can we improve care and outcomes even further?

“…Compounding this challenge are oncologic sepsis mimics (Table 2), which are becoming more common and more protean as novel therapies introduce new entities such as the cytokine release syndrome [16 ▪ ,30–34,62 ▪ ]. These emerging treatments have brought analogous pathologies (e.g., idiopathic pneumonia syndrome, checkpoint inhibitor pneumonitis) into the differential diagnosis of acute respiratory failure [16 ▪ ,23,30–34,46]. Finally, seeking subphenotypes within a narrower population – even one as complex as patients with cancer – may offer a degree of practical enrichment for observational research and clinical trials [81].…”

“…Cancer itself is a heterogeneous set of disease states from numerous clinical and -omics perspectives [86–89], adding an additional dimension through which heterogeneity of treatment effect might manifest in the ICU. Compounding this challenge are oncologic sepsis mimics (Table 2), which are becoming more common and more protean as novel therapies introduce new entities such as the cytokine release syndrome [16 ▪ ,30–34,62 ▪ ]. These emerging treatments have brought analogous pathologies (e.g., idiopathic pneumonia syndrome, checkpoint inhibitor pneumonitis) into the differential diagnosis of acute respiratory failure [16 ▪ ,23,30–34,46].…”

“…These numbers are likely to increase, as cancer prevalence is rising due to aging populations, lifestyle factors, screening, and improved cancer treatments and survival [3–7]. Simultaneously, management and outcomes have improved for critically ill patients with cancer [8–13], appropriately leading to broadened eligibility for ICU admission and therapies among this population in consensus guidelines [14,15,16 ▪ ]. Regional mortality variation for critically ill patients with cancer is substantial, suggesting that care delivery practices may have a sizable impact on outcomes [17 ▪ ].…”

Outcomes in Young Patients After Respiratory Extracorporeal Membrane Oxygenation—Youth Is Not Always Protective*

“…The study included patients managed over 3 decades, during which time there were many changes in management strategies before and during ECMO which were difficult to control for. There were also changes in the indications for ECMO, with an increasing tendency to cannulate patients with conditions previously regarded as contraindications, such as septic shock and respiratory failure following hematopoietic cell transplantation (18)(19)(20)(21). This may have paradoxically worsened outcomes in recent years.…”

What’s new in adult extracorporeal membrane oxygenation in 2022–2023? Insights from the EuroELSO congress 2023

“…Addressing this challenge, an international panel of experts published a consensus statement in the Lancet Respiratory Medicine to offer guidance to intensivists and hematologists struggling with the ECMO candidacy decision-making process in this specific population. 10 The key points outlined were: (1) HCT should no longer be an absolute contraindication for ECMO; (2) The evaluation of ECMO eligibility should involve a collaborative effort encompassing an interprofessional team, which includes the patient or their surrogate decision-makers; and (3) ECMO should be proposed solely for patients receiving HCT due to non-malignant conditions or malignancies in documented remission, and only when the risk of recurrence at the time of ECMO assessment is low.…”