Extracorporeal Membrane Oxygenation Support as a Bridge to Recovery during Chemotherapy in a Young Patient with Metastatic Choriocarcinoma and Severe Acute Respiratory Distress Syndrome

Abstract

• Polychemotherapy in choriocarcinoma triggers acute respiratory distress syndrome (ARDS). • Choriocarcinoma is curable, but severe ARDS leads to death. Novel Insights • Extracorporeal membrane oxygenation (ECMO) support enables continuation of polychemotherapy in severe ARDS as a bridge to recovery. • ECMO support should not be excluded a priori for cancer patients and deserves consideration as a rescue therapy for patients with at least stable disease and eligible for full-code intensive care unit management. • An interdisciplinary strategy combining polychemotherapy and intensive care support including ECMO support may enable a curative approach also in patients with metastatic choriocarcinoma and ARDS.

Choriocarcinoma syndrome of primary pulmonary choriocarcinoma after lung lobe resection: A case report and review of the literature

“…Our study includes a literature review of CS cases published from 2012 to 2021. These cases are included in Table 1 [4,[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. The patients with clinical data in the publications were aged from 8 to 64 years.…”

Extracorporeal Membrane Oxygenation to Facilitate Chemotherapy—Moving the Goalposts!

“…Both VA-ECMO and veno-venous ECMO have been successfully described as a bridge to chemotherapy. The use of ECMO as a bridge to chemotherapy has been reported in children with hematologic malignancies [11], both children and adults with other chemotherapy-sensitive mediastinal malignancies [3][4][5][6][7]12], and even a pregnant woman at full term with mediastinal lymphoma, cardiogenic shock, and superior vena cava (SVC) syndrome [13].…”

“…Use of ECMO in critically ill patients with cancer is a contentious issue given the immunocompromised state, high risk for bleeding secondary to thrombocytopenia or other hematological derangements, risk for sepsis secondary to neutropenia, and reduced life expectancy [2]. Despite this, there have been multiple reports on the use of both veno-venous and veno-arterial ECMO to facilitate chemotherapy in the management of both adult and pediatric patients with various malignancies causing cardiopulmonary compromise [3][4][5][6][7]. Veno-arterialvenous ECMO (VAV-ECMO) also has the potential to not only provide cardio-respiratory support but also facilitate chemotherapy in patients with metastatic malignancy.…”

Acute cardiopulmonary failure in a young woman with high-risk gestational trophoblastic neoplasia: A case of induction chemotherapy during extracorporeal membrane oxygenation

“…Use of chemotherapy for treatment of GTN while on or in close proximity to ECMO is limited to few case reports ( Sekandarzad et al, 2020 , Chung et al, 2017 ). Chung et al described administration of one cycle of EMA-CO while a patient was on ECMO after pulmonary embolectomy for choriocarcinoma tumor embolus ( Chung et al, 2017 ).…”

“…Due to persistent hypoxemia, the patient underwent cannulation for ECMO and was restarted on EMA-CO after a delay of six days. This patient required re-initiation of ECMO for 21 days during the second and third cycles of chemotherapy ( Sekandarzad et al, 2020 ).…”