Extracorporeal membrane oxygenation in children receiving haematopoietic cell transplantation and immune effector cell therapy: an international and multidisciplinary consensus statement

The Use of Extracorporeal Membrane Oxygenation as a Bridge to Bone Marrow Transplantation in a Patient With High-risk Acute Myeloid Leukemia

“…Earlier this year, the hematopoietic cell transplantation-cancer immunotherapy subgroup of The Pediatric Acute Lung Injury and Sepsis Investigators released a framework to guide the clinical team when considering ECMO support for patients post-HSCT 4. This effort was further supported by the publication of the first consensus-based international guidelines for the use of life support in pediatric children who have received HSCT or immune effector cell therapy 5. Both recognize the limitation of available data, which is insufficient to define optimal candidacy in such a heterogeneous and challenging population 4,5.…”

“…5 Both recognize the limitation of available data, which is insufficient to define optimal candidacy in such a heterogeneous and challenging population. 4,5 Our report describes the use of ECMO as a bridge to a successful HSCT in an 18-year-old girl with high-risk AML and heart failure. It also highlights the integration of the newly published criteria in the decision making process even before transplantation.…”

“…4,5 This was published along with the recognition of the criteria limitations in such a heterogeneous and challenging population. 5 This case report describes the use of ECMO as a bridge to HSCT in an 18-year-old girl with high-risk acute myeloid leukemia (AML), who developed Streptococcus mitis septic shock, multiorgan dysfunction syndrome, and cardiogenic shock with biventricular failure. It also highlights some of the newly published guidelines on the use of ECMO in children after HSCT and depicts their use in a pretransplant patient.…”

“…Although available data remains insufficient to define optimal candidacy for cannulation, a consensus-based framework and international multidisciplinary recommendations were recently released to guide the clinical team in this decision. 4,5 This was published along with the recognition of the criteria limitations in such a heterogeneous and challenging population. 5 This case report describes the use of ECMO as a bridge to HSCT in an 18-year-old girl with high-risk acute myeloid leukemia (AML), who developed Streptococcus mitis septic shock, multiorgan dysfunction syndrome, and cardiogenic shock with biventricular failure.…”

“…For a while, there have been no well-defined initiation criteria, risk stratification, or treatment protocols for this therapy in this specific patient population. Although available data remains insufficient to define optimal candidacy for cannulation, a consensus-based framework and international multidisciplinary recommendations were recently released to guide the clinical team in this decision 4,5. This was published along with the recognition of the criteria limitations in such a heterogeneous and challenging population 5.…”