Outcomes of extracorporeal membrane oxygenation in adults with active hematologic and nonhematologic malignancy

Abstract

Although the number of cancer patients admitted to the intensive care unit is increasing, the data on the use of extracorporeal membrane oxygenation in patients with malignancy are limited. We applied extracorporeal membrane oxygenation to carefully selected patients with active hematologic malignancy or nonhematologic malignancy who experienced respiratory or cardiac failure despite maximal conventional therapy. Patients with active malignancy who underwent extracorporeal membrane oxygenation in our institution between January 2012 and December 2016 were included in this study. The primary outcome of this study was defined as survival to hospital discharge. We also investigated the factors associated with survival to hospital discharge. There were 30 (30.6%) and 68 (69.4%) patients in the hematologic malignancy group and the nonhematologic malignancy group, respectively. Patients in the hematologic malignancy group were younger, more neutropenic, more hypotensive, had a lower Charlson Comorbidity Index, higher sequential organ failure assessment score, and lower platelet count than those in the nonhematologic malignancy group. Forty-six (46.9%) patients were successfully weaned off extracorporeal membrane oxygenation, and 30 (30.6%) patients survived until hospital discharge.Hospital survival rate and survival status 6 months after hospital discharge were significantly lower in patients with hematologic malignancy than in those with nonhematologic malignancy (13.3% vs. 38.2%, P = .026 and 3.3% vs. 26.5%, P = .017, respectively). Multivariate analysis identified an active hematologic malignancy, older age, acidosis, thrombocytopenia, high vasoactive-inotrope score, and respiratory failure as the risk factors for in-hospital death. Patients with hematologic malignancy requiring extracorporeal membrane oxygenation support had significantly lower rates of hospital survival and 6-month survival after discharge than patients with nonhematologic malignancy. Therefore, extracorporeal membrane oxygenation for treating cardiac or respiratory failure should only be considered in highly selected patients with hematologic malignancy.

Contraindications to the Initiation of Veno-Venous ECMO for Severe Acute Respiratory Failure in Adults: A Systematic Review and Practical Approach Based on the Current Literature

“…Admission due to ARF is associated with poor outcomes [ 112 , 113 , 114 ] and worsens if invasive mechanical ventilation is needed [ 115 , 116 ]. Nevertheless, efforts have been made in patients with hematologic malignancy to bridge ARF to recovery by use of ECMO [ 76 , 80 , 117 , 118 , 119 , 120 , 121 , 122 ]. All these trials conducted over a period of more than 10 years consistently demonstrated a high ICU and in-hospital mortality of more than 50% for patients treated with ECMO ( Table 6 ).…”

Expert consensus of perioperative intensive care and management of critically ill cancer patients (2021)

“…Subgroup analysis demonstrated that hematological malignancies had the lowest 6-month survival compared with other immunodeficiency severe ARDS patients and patients with solid tumor (P=0.02). In another study including 68 nonhematologic malignancy patients with respiratory or cardiac failure who received ECMO as salvage therapy despite conventional therapy, the 6-month survival was 26.5% (20).…”

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

“…Patients with hematologic malignancy patients had increased risk of bleeding compared with solid malignancies (44% versus 33%) [ 85 ]. Another study of patients with cancer treated with ECMO showed lower survival in-hospital (13% vs 38%) and 6-month survival (3% vs 26%) rates among patients with hematologic malignancies compared with solid tumors [ 86 ]. 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 ].…”