The Feasibility of Venovenous Extracorporeal Life Support to Treat Acute Respiratory Failure in Adult Cancer Patients. Issue 21 (May 2015)

• Record Type: Journal Article
• Authors: Wu, Meng-Yu; Wu, Tzu-I.; Tseng, Yuan-His; Shen, Wen-Chi; Chang, Yu-Sheng; Huang, Chung-Chi; Lin, Pyng-Jing; Foreman., Michael L.
• Is Part Of: Medicine. Volume 94:Issue 21(2015)
• Publication Date: 2015-05
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000000893
• Languages: English
• ISSNs: 0025-7974

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Abstract</title> <p>Venovenous extracorporeal life support (VV-ECLS) is a lifesaving but invasive treatment for acute respiratory failure (ARF) that is not improved with conventional therapy. However, using VV-ECLS to treat ARF in adult cancer patients is controversial.</p> <p>This retrospective study included 14 cancer patients (median age: 58 years [interquartile range: 51–66]; solid malignancies in 13 patients and hematological malignancy in 1 patient) who received VV-ECLS for ARF that developed within 3 months after anticancer therapies. VV-ECLS would be considered in selected patients with a P<sub>a</sub>O<sub>2</sub>/F<sub>i</sub>O<sub>2</sub> ratio ⩽70 mmHg under advanced mechanical ventilation.</p> <p>Before ECLS, the medians of intubation day, P<sub>a</sub>O<sub>2</sub>/F<sub>i</sub>O<sub>2</sub> ratio, and Sequential Organ Failure Assessment (SOFA) score were 8 (2–12), 62 mmHg (53–76), and 10 (9–14), respectively. The case numbers of bacteremia, thrombocytopenia (platelet count <50000 cells/μL), and neutropenia (actual neutrophil count <1000 cells/μL) detected before ECLS were 3 (21%), 2 (14%), and 1 (7%), respectively. After 24 hours of ECLS, a significant improvement was seen in P<sub>a</sub>O<sub>2</sub>/F<sub>i</sub>O<sub>2</sub> ratio but not in SOFA score. Six patients experienced major hemorrhages during ECLS. The median ECLS day, ECLS weaning rate, and hospital survival were 11 (7–16), 50% (n = 7), and 29% (n = 4). The development of dialysis-dependent nephropathy predicted death on ECLS (odds ratio: 36; 95% confidence interval: 1.8–718.7; <italic>P</italic> = 0.01). With a median follow-up of 11 (6–43) months, half of the survivors died of cancer recurrence and the others were in partial remission.</p> <p>The most prominent benefit of VV-ECLS is to improve the arterial oxygenation and rest the lungs. This may increase the chance of recovery from ARF in selected cancer patients.</p> </sec> </abstract>