Extracorporeal membrane oxygenation in patients with hematologic malignancies: a systematic review and meta-analysis

Sim, Jackie Jia Lin; Safari, Mitra; Ling, Ryan Ruiyang; Tan, Chuen Seng; Fan, Bingwen Eugene; MacLaren, Graeme; Ramanathan, Kollengode

doi:10.1007/s00277-022-04855-2

Cited by 7 publications

(3 citation statements)

References 38 publications

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“…For multivariate analysis, Cox regression was used including the following variables selected on the basis of the literature: age at ECMO initiation, immunocompromised status, mechanical ventilation duration before ECMO initiation, driving pressure before ECMO initiation, and awake strategy ( 11 , 17 – 19 ). To account for bias in variable selection, the regression was repeated using a least absolute shrinkage and selection operator (LASSO) analysis, which was cross-validated and subjected to a final LASSO analysis to select the optimal variables among those completed in >90% of patients.…”

Section: Methodsmentioning

confidence: 99%

Survival and Long-Term Functional Status of COVID-19 Patients Requiring Prolonged Extracorporeal Membrane Oxygenation Support

Martínez-Martínez,

Schmidt,

Broman

et al. 2024

Annals ATS

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Rationale Severe cases of acute respiratory distress syndrome (ARDS) may require prolonged (>28 d) extracorporeal membrane oxygenation (ECMO). In nonresolving disease, recovery is uncertain, and lung transplant may be proposed. Objectives This study aims to identify the variables influencing survival and to describe the functional status of these patients at 6 months. Methods This was a retrospective, multicenter, observational cohort study including patients requiring ECMO support for coronavirus disease (COVID-19)-related ARDS for >28 days. Multivariate analysis was performed using Cox regression in preselected variables and in least absolute shrinkage and selection operator selected variables. In a post hoc analysis to account for confounders and differences in awake strategy use by centers, treatment effects of the awake strategy were estimated using an augmented inverse probability weighting estimator with robust standard errors clustered by center. Results Between March 15, 2020 and March 15, 2021, 120 patients required ECMO for >28 days. Sixty-four patients (53.3%) survived decannulation, 62 (51.7%) were alive at hospital discharge, and 61 (50.8%) were alive at 6-month follow-up. In the multivariate analysis, age (1.09; 95% confidence interval [CI], 1.03–1.15; P = 0.002) and an awake ECMO strategy (defined as the patient being awake, cooperative, and performing rehabilitation and physiotherapy with or without invasive mechanical ventilation at any time during the extracorporeal support) (0.14; 95% CI, 0.03–0.47; P = 0.003) were found to be predictors of hospital survival. At 6 months, 51 (42.5%) patients were at home, 42 (84.3%) of them without oxygen therapy. A cutoff point of 47 ECMO days had a 100% (95% CI, 76.8–100%) sensitivity and 60% (95% CI, 44.3–73.6%) specificity for oxygen therapy at 6 months, with 100% specificity being found in 97 days. Conclusions Patients with COVID-19 who require ECMO for >28 days can survive with nonlimiting lung impairment. Age and an awake ECMO strategy may be associated with survival. Longer duration of support correlates with need for oxygen therapy at 6 months.

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Section: Methodsmentioning

confidence: 99%

Survival and Long-Term Functional Status of COVID-19 Patients Requiring Prolonged Extracorporeal Membrane Oxygenation Support

Martínez-Martínez,

Schmidt,

Broman

et al. 2024

Annals ATS

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“…In a small, single-center study of 23 patients with hematologic malignancies on ECMO (14 on veno-arterial ECMO and 9 on VV-ECMO), there was a significant rate of in-hospital mortality with 91% of patients dying after a median ECMO duration of 105 h [ 87 ]. A meta-analysis of 13 observational studies (including 422 patients with hematologic malignancies) showed a pooled in-hospital mortality rate of 79% [ 88 ]. These studies suggest that patient selection is important for the determination of ECMO utilization in patients with cancer, particularly those with hematologic cancers.…”

Section: Heart Failure Shock and Temporary Mechanical Circulatory Sup...mentioning

confidence: 99%

Interventional Cardio-Oncology: Unique Challenges and Considerations in a High-Risk Population

Leiva

Alam

Bohart

et al. 2023

Curr. Treat. Options in Oncol.

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Opinion StatementPatients with cancer are at risk of developing cardiovascular disease (CVD) including atherosclerotic heart disease (AHD), valvular heart disease (VHD), and atrial fibrillation (AF). Advances in percutaneous catheter-based treatments, including percutaneous coronary intervention (PCI) for AHD, percutaneous valve replacement or repair for VHD, and ablation and left atrial appendage occlusion devices (LAAODs) for AF, have provided patients with CVD significant benefit in the recent decades. However, trials and registries investigating outcomes of these procedures often exclude patients with cancer. As a result, patients with cancer are less likely to undergo these therapies despite their benefits. Despite the inclusion of cancer patients in randomized clinical trial data, studies suggest that cancer patients derive similar benefits of percutaneous therapies for CVD compared with patients without cancer. Therefore, percutaneous interventions for CVD should not be withheld in patients with cancer, as they may still benefit from these procedures.

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“…The complexity of HSCT and the critical presentation of ARDS made it difficult for these patients to benefit from ECMO therapy [ 1 , 2 ]. The in-hospital mortality for HSCT patients using ECMO was significantly higher than those who did not receive HSCT [ 3 – 5 ]. ECMO is a highly technical life-saving intervention, and given the resources required and the practical benefits gained, ECMO was rarely used in patients with HSCT.…”

Section: Introductionmentioning

confidence: 99%

Extracorporeal membrane oxygenation in long-term COVID-19 with severe neutropenia and thrombocytopenia after allogeneic hematopoietic stem cell transplantation: a case report

Guo,

Zhang,

Gao

et al. 2024

BMC Infect Dis

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Background Hematopoietic stem cell transplantation (HSCT) was associated with potentially life-threatening complications. Among patients supported by extracorporeal membrane oxygenation (ECMO), those who underwent HSCT had a worse prognosis than those who did not. Advances in HSCT and critical care management have improved the prognosis of ECMO-supported HSCT patients. Case The patient in the remission stage of lymphoma after 22 months of allogeneic hematopoietic stem cell transplantation, suffered from ARDS, severe neutropenia, thrombocytopenia, and long-term COVID-19. We evaluated the benefits and risks of ECMO for the patient, including the possibility of being free from ECMO, the status of malignancy, the interval from HSCT to ARDS, the function of the graft, the amount of organ failure, and the comorbidities. ECMO was ultimately used to save his life. Conclusions We did not advocate for the general use of ECMO in HSCT patients and we believed that highly selected patients, with well-controlled tumors, few comorbidities, and fewer risk factors for death, tended to benefit from ECMO with well ICU management.

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Extracorporeal membrane oxygenation in patients with hematologic malignancies: a systematic review and meta-analysis

Cited by 7 publications

References 38 publications

Survival and Long-Term Functional Status of COVID-19 Patients Requiring Prolonged Extracorporeal Membrane Oxygenation Support

Survival and Long-Term Functional Status of COVID-19 Patients Requiring Prolonged Extracorporeal Membrane Oxygenation Support

Interventional Cardio-Oncology: Unique Challenges and Considerations in a High-Risk Population

Extracorporeal membrane oxygenation in long-term COVID-19 with severe neutropenia and thrombocytopenia after allogeneic hematopoietic stem cell transplantation: a case report

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