The Utility of Extracorporeal Membrane Oxygenation in Patients With Hematologic Malignancies: A Literature Review

Tathineni, Praveena; Pandya, Mauna; Chaar, Bassem T.

doi:10.7759/cureus.9118

Cited by 8 publications

(11 citation statements)

References 24 publications

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“…In a report by Wohlfarth et al among patients with hematological malignancy and acute respiratory failure, ECMO was successfully weaned in 10 out of 17 episodes (59%), and seven patients survived until discharge ( 24 ). A series of case reports have also suggested the potential role of ECMO as a bridge to curative chemotherapy in patients with hematological malignancies ( 25 ). For patients with autoimmune diseases, several studies have also reported that ECMO may serve as a bridge to immunomodulation in patients with pulmonary hemorrhage related to ANCA-associated vasculitis and systemic lupus erythematous ( 26 , 27 ).…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation in Immunocompromised Patients With Acute Respiratory Distress Syndrome—A Retrospective Cohort Study

et al. 2021

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Objective: Although the negative impact of immunosuppression on survival in patients with acute respiratory distress syndrome (ARDS) treated by extracorporeal membrane oxygenation (ECMO) is well known, short-term outcomes such as successful weaning rate from ECMO and subgroups benefit most from ECMO remain to be determined. The aims of this study were (1) to identify the association between immunocompromised status and weaning from ECMO in patients of ARDS, and (2) to identify subgroups of immunocompromised patients who may benefit from ECMO.Methods: This retrospective cohort study enrolled patients who received ECMO for ARDS from 2010 to 2020. Immunocompromised status was defined as having a hematological malignancy, active solid tumor, solid organ transplant, or autoimmune disease.Results: This study enrolled 256 ARDS patients who received ECMO, of whom 68 were immunocompromised. The multivariable analysis showed that immunocompromised status was not independently associated with failure to wean from ECMO. In addition, the patients with an autoimmune disease (14/24, 58.3%) and organ transplantation (3/3, 100%) had a numerically higher weaning rate from ECMO than other immunocompromised patients. For causes of ARDS, most patients with pulmonary hemorrhage (6/8, 75%) and aspiration (5/9, 55.6%) could be weaned from ECMO, compared to only a few of the patients with interstitial lung disease (2/9, 22.2%) and sepsis (1/4, 25%).Conclusions: Immunocompromised status was not an independent risk factor of failure to wean from ECMO in patients with ARDS. For patients with pulmonary hemorrhage and aspiration-related ARDS, ECMO may be beneficial as bridge therapy.

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Section: Discussionmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation in Immunocompromised Patients With Acute Respiratory Distress Syndrome—A Retrospective Cohort Study

et al. 2021

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“…In cases of hematological malignancies, early initiation of chemotherapy after a definitive diagnosis is critical to improving survival. An ECMO might be useful as a bridge to chemotherapy in patients with airway emergencies to increase the survival rate for such patients [ 4 ]; however, remission-induction chemotherapy causes neutropenia and an immunocompromised state, placing patients at risk of severe infections, such as ventilator-associated pneumonia. In such situations, ES may shorten the intensive care period [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Airway Emergencies Due to Anterior Mediastinal T-Lymphoblastic Lymphoma Managed With Planned Extracorporeal Membrane Oxygenation and Endotracheal Stent: A Case Report and Literature Review

Oyake¹,

Suenobu²,

Miyawaki³

et al. 2022

Cureus

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Anterior mediastinal tumors can occasionally cause acute respiratory failure by compressing the trachea and bronchi. In such cases, sedative muscle relaxants during tracheal intubation can cause fatal complete tracheal obstruction. We encountered a 15-year-old male patient with T-lymphoblastic lymphoma (T-LBL) of the anterior mediastinum. For his airway emergency due to the stenosis extended from the lower part of the trachea to the tracheal bifurcation, venovenous (VV) extracorporeal membrane oxygenation (ECMO) was introduced from the femoral vein under local anesthesia. After a short period of tracheal intubation management, an endotracheal stent (ES) was immediately placed in the lower trachea. We performed a needle biopsy, and he was diagnosed with T-LBL. Following the diagnosis, chemotherapy was introduced.The ES was able to secure sufficient tracheal diameter, and ECMO and ventilation were promptly discontinued. In the case of tracheal stenosis from the lower part of the trachea due to anterior mediastinal tumor, depending on the degree of stenosis, VV ECMO can be considered. Moreover, ES can lead to early weaning from VV ECMO and a ventilator.

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“…Interestingly, 365‐day mortality due to cancer was highest in the other diagnoses group (36.7%), suggesting that many cancer patients received ECMO support during cancer treatment. Cancer often causes unpredictable cardiac or respiratory failure during treatment, which requires temporary ECMO support 25,26 . In particular, there are reports that ECMO support may be a useful treatment option for patients with lung cancer or hematologic malignancies 25–27 .…”

Section: Discussionmentioning

confidence: 99%

Mortality trends after extracorporeal membrane oxygenation support: A Korean Nationwide cohort

Cho

Song

2022

Artificial Organs

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Background: This study aimed to investigate the prevalence of 7-, 30-, 60-, and 365-day overall and cause-specific mortality following extracorporeal membrane oxygenation (ECMO) support. Methods:The National Health Insurance claims database in South Korea was the data source for this population-based cohort study. We enrolled all adult patients aged ≥18 years receiving intensive care unit ECMO support from January 1, 2005 to December 31, 2018. The study population was divided into three groups based on the main diagnoses during ECMO support: (1) cardiovascular, (2) respiratory, and (3) other diagnoses group (all other main diagnoses rather than cardiovascular or respiratory diseases).Results: A total of 18 697 patients were included in the final analysis (64.5%, 10.9%, and 24.6% in the cardiovascular, respiratory, and other groups, respectively). The corresponding 7-, 30-, 60-, and 365-day mortality rates in these groups were 33.1%, 56.1%, 62.4%, and 67.7%. Kaplan-Meier curves demonstrated that the median survival time was shortest in the cardiovascular group (12.0 days, 95% confidence interval [CI]: 11.3-12.7), with 31.0 (95% CI: 28.5-33.6) and 49.0 (95% CI: 44.4-57.6) day survival in the respiratory and other diagnoses groups (p < 0.001). Conclusions:Approximately one-third of patients died within 7 days, half of the patients died within 30 days, and two-thirds died within 365 days of ECMO support. Overall survival time was shortest in the cardiovascular group, followed by that of the respiratory group.

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The Utility of Extracorporeal Membrane Oxygenation in Patients With Hematologic Malignancies: A Literature Review

Cited by 8 publications

References 24 publications

Extracorporeal Membrane Oxygenation in Immunocompromised Patients With Acute Respiratory Distress Syndrome—A Retrospective Cohort Study

Extracorporeal Membrane Oxygenation in Immunocompromised Patients With Acute Respiratory Distress Syndrome—A Retrospective Cohort Study

Airway Emergencies Due to Anterior Mediastinal T-Lymphoblastic Lymphoma Managed With Planned Extracorporeal Membrane Oxygenation and Endotracheal Stent: A Case Report and Literature Review

Mortality trends after extracorporeal membrane oxygenation support: A Korean Nationwide cohort

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