Outcomes of pediatric patients with oncologic disease or following hematopoietic stem cell transplant supported on extracorporeal membrane oxygenation: The PEDECOR experience

Abstract

Background Outcomes for patients with oncologic disease and/or after hematopoietic stem cell transplant (HSCT) requiring intensive care unit admission have improved, but indications for and outcomes after extracorporeal membrane oxygenation (ECMO) support in this population are poorly characterized. Procedure We analyzed data from consecutive patients < 18 years with oncologic disease and/or after HSCT reported to a pediatric ECMO registry by nine pediatric centers in the United States between 2011 and 2018. Results We identified 18 ECMO patients with oncologic disease and/or HSCT, and 415 ECMO controls matched with a propensity score algorithm based on age, gender, race, severity of illness at admission, and reason for ECMO. The primary indication for ECMO was respiratory failure in 66.7% in the oncologic disease and/or HSCT group, and in 70.7% in the matched ECMO control group. Eleven of 18 patients survived to hospital discharge (61.1%), similar to the matched control group (60.8%), P = 0.979. Children with oncologic disease and/or HSCT had lower mean platelet counts during ECMO and received higher volumes of platelets compared with the control group, mean 14.6 mL/kg/day (standard deviations [SD], 9.8) versus mean 9.3 mL/kg/day (SD, 10.4), P = 0.001. Of the 11 surviving children with oncologic disease and/or HSCT, five sustained new neurologic disorders (45.5%) versus 45 of 222 (20.3%) in the control group, P = 0.061. Bleeding complications were similar in the two groups. Conclusions Outcomes of patients with oncologic disease and/or HSCT supported on ECMO in the current era are not significantly different compared with matched ECMO controls and are improved from previously published reports.

Pediatric oncology—The final frontier for extracorporeal membrane oxygenation in children?

“…1 nor other markers of severity of illness. 10 Daily average platelet volume transfused was higher in ECMO supported patients with oncological diagnoses and/or HSCT than others, which is a resource to be considered for centers potentially offering this invasive therapy. The authors found that survival to hospital discharge in critically ill children with oncological diagnoses supported on ECMO was 61% overall, 50% in the higher risk subgroup of HSCT patients.…”

“…ECMO has been strategically deployed in response to oncological diagnoses leading to symptoms or signs of airway obstruction, failure to achieve respiratory gas exchange in the setting of infectious or infiltrative pulmonary processes, distributive shock associated with sepsis, or cardiogenic shock associated with impaired ventricular systolic function postchemotherapy 6‐8 . In this issue of the journal, two studies illustrate the potential for successful management of complex children with oncological disease or following hemopoietic stem cell transplantation (HSCT) for other diagnoses 9,10 …”

“…While the inclusion criteria were restricted to patients with oncological diagnoses and/or management, the nature of the diseases still results in a heterogeneous population. Propensity matching was successful, with no differences in the baseline pediatric index of mortality 2 (PIM2) and pediatric risk of mortality III (PRISM III) scores, primary indications for ECMO, presence and type of infections pre‐ECMO, duration of intensive care unit (ICU) admission pre‐ECMO, ECMO mode or duration, nor other markers of severity of illness 10 . Daily average platelet volume transfused was higher in ECMO supported patients with oncological diagnoses and/or HSCT than others, which is a resource to be considered for centers potentially offering this invasive therapy.…”

“…[6][7][8] In this issue of the journal, two studies illustrate the potential for successful management of complex children with oncological disease or following hemopoietic stem cell transplantation (HSCT) for other diagnoses. 9,10 In the larger study, Steppan and colleagues leverage multicenter data from the granular Pediatric ECMO Outcomes Registry (PEDECOR, a collaboration within the Pediatric Acute Lung Injury and Sepsis Investigators, PALISI Network), 11 to describe a cohort of children with oncological diagnoses and/or HSCT treatment who were managed on ECMO. 10 The premise of this analysis is the widening indications for ECMO cannulation without empiric evidence of benefits and harms in this population.…”

“…9,10 In the larger study, Steppan and colleagues leverage multicenter data from the granular Pediatric ECMO Outcomes Registry (PEDECOR, a collaboration within the Pediatric Acute Lung Injury and Sepsis Investigators, PALISI Network), 11 to describe a cohort of children with oncological diagnoses and/or HSCT treatment who were managed on ECMO. 10 The premise of this analysis is the widening indications for ECMO cannulation without empiric evidence of benefits and harms in this population. 1 nor other markers of severity of illness.…”