Veno-arterial extracorporeal membrane oxygenationas a bridge to cytolytic therapy

Abstract

We describe a case of successful use of veno-arterial (VA) extracorporeal membrane oxygenation (ECMO), as a bridge to cytoreductive therapy, in a patient with large mediastinal mass due to T cell lymphoblastic leukemia, complicated by acute cardiorespiratory compromise from mechanical compression and pulmonary embolism. Electronic supplementary material The online version of this article (10.1007/s12055-020-00992-3) contains supplementary material, which is available to authorized users.

Extracorporeal Membrane Oxygenation to Facilitate Chemotherapy—Moving the Goalposts!

“…Despite this, both guidelines acknowledge that ECMO, in select patient populations, may be a beneficial life-sustaining therapy despite the provided contraindications. As previously stated, there are multiple reports on the successful use of ECMO in a variety of different patient populations with hematologic and solid tumor cancers [3][4][5][6][7][9][10][11][12][13]. As such, we believe that the use of ECMO was justified in our patient given a supportive, multidisciplinary team of surgical and medical experts who agreed upon the treatment plan, as well as patient-specific factors such as age and chemo-sensitive nature of primary tumor.…”

“…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].…”