Outcomes of extracorporeal membrane oxygenation in adults with active hematologic and nonhematologic malignancy. Issue 8 (29th March 2021)

• Record Type: Journal Article
• Authors: Park, Chul; Ko, Ui Won; Ko, Ryoung‐Eun; Na, Soo Jin; Yang, Jeong Hoon; Jeon, Kyeongman; Suh, Gee Young; Sung, Kiick; Cho, Yang Hyun
• Is Part Of: Artificial organs. Volume 45:Issue 8(2021)
• Page Start: E236
• Page End: E246
• Publication Date: 2021-03-29
• Subjects: extracorporeal membrane oxygenation -- hematology -- malignancy -- outcome; Artificial organs -- Periodicals; 617.956
• DOI: 10.1111/aor.13922
• Languages: English
• ISSNs: 0160-564X

Abstract

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. Abstract : The survival to hospital discharge and 6‐month survival after hospital discharge were significantly lower in patients with hematologic malignancy than in patients with nonhematologic malignancy who received extracorporeal membrane oxygenation (ECMO). Although ECMO may still be used in patients with malignancy, its applicatioshould be discouraged in patients with hematologic malignancy; ECMO should be performed in those patients only after careful review and a multidisciplinary team discussion.