Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Extracorporeal Life Support in Adult Patients with Hematologic Malignancies and Acute Circulatory and/or Respiratory Failure

  • Cho, Sungbin (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Cho, Won Chul (Department of Thoracic and Cardiovascular Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine) ;
  • Lim, Ju Yong (Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Korea University College of Medicine) ;
  • Kang, Pil Je (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2018.08.29
  • Accepted : 2018.11.05
  • Published : 2019.02.05
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Abstract

Background: The primary goal of this study was to characterize the clinical outcomes of adult patients with hematologic malignancies (HM) who were treated with extracorporeal membrane oxygenation (ECMO) support when conventional treatments failed. Methods: In this retrospective, observational study at a tertiary medical center, we reviewed the clinical course of 23 consecutive patients with HM requiring ECMO who were admitted to the intensive care unit at Asan Medical Center from March 2010 to April 2015. Results: A total of 23 patients (8 female; median age, 44 years; range, 29-51 years) with HM and severe acute circulatory and/or respiratory failure received ECMO therapy during the study period. Fourteen patients received veno-arterial ECMO, while 9 patients received veno-venous ECMO. The median ECMO duration was 104.7 hours (range, 37.1-221 hours). Nine patients were successfully weaned from ECMO. The in-hospital mortality rate was 91.1% (21 of 23). There were complications in 3 patients (cannulation site bleeding, limb ischemia, and gastrointestinal bleeding). Conclusion: ECMO is a useful treatment for patients with circulatory and/or pulmonary failure. However, in patients with HM, the outcomes of ECMO treatment results were very poor, so it is advisable to carefully decide whether to apply ECMO to these patients.

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References

  1. Le Gall A, Follin A, Cholley B, Mantz J, Aissaoui N, Pirracchio R. Veno-arterial-ECMO in the intensive care unit: from technical aspects to clinical practice. Anaesth Crit Care Pain Med 2018;37:259-68. https://doi.org/10.1016/j.accpm.2017.08.007
  2. Wu MY, Huang CC, Wu TI, Wang CL, Lin PJ. Venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome in adults: prognostic factors for outcomes. Medicine (Baltimore) 2016;95:e2870. https://doi.org/10.1097/MD.0000000000002870
  3. Thiagarajan RR, Barbaro RP, Rycus PT, et al. Extracorporeal Life Support Organization registry international report 2016. ASAIO J 2017;63:60-7. https://doi.org/10.1097/MAT.0000000000000475
  4. Azoulay E, Pene F, Darmon M, et al. Managing critically Ill hematology patients: time to think differently. Blood Rev 2015;29:359-67. https://doi.org/10.1016/j.blre.2015.04.002
  5. Hampshire PA, Welch CA, McCrossan LA, Francis K, Harrison DA. Admission factors associated with hospital mortality in patients with haematological malignancy admitted to UK adult, general critical care units: a secondary analysis of the ICNARC Case Mix Programme Database. Crit Care 2009;13:R137. https://doi.org/10.1186/cc8016
  6. Aygencel G, Turkoglu M, Turkoz Sucak G, Benekli M. Prognostic factors in critically ill cancer patients admitted to the intensive care unit. J Crit Care 2014;29:618-26. https://doi.org/10.1016/j.jcrc.2014.01.014
  7. Massion PB, Dive AM, Doyen C, et al. Prognosis of hematologic malignancies does not predict intensive care unit mortality. Crit Care Med 2002;30:2260-70. https://doi.org/10.1097/00003246-200210000-00014
  8. Seong GM, Lee Y, Hong SB, Lim CM, Koh Y, Huh JW. Prognosis of acute respiratory distress syndrome in patients with hematological malignancies. J Intensive Care Med 2018:885066617753566.
  9. Choi KB, Kim HW, Jo KH, Kim DY, Choi HJ, Hong SB. Extracorporeal life support in patients with hematologic malignancies: a single center experience. Korean J Thorac Cardiovasc Surg 2016;49:280-6. https://doi.org/10.5090/kjtcs.2016.49.4.280
  10. Kang HS, Rhee CK, Lee HY, et al. Clinical outcomes of extracorporeal membrane oxygenation support in patients with hematologic malignancies. Korean J Intern Med 2015;30:478-88. https://doi.org/10.3904/kjim.2015.30.4.478
  11. Wohlfarth P, Ullrich R, Staudinger T, et al. Extracorporeal membrane oxygenation in adult patients with hematologic malignancies and severe acute respiratory failure. Crit Care 2014;18:R20. https://doi.org/10.1186/cc13701
  12. Wohlfarth P, Beutel G, Lebiedz P, et al. Characteristics and outcome of patients after allogeneic hematopoietic stem cell transplantation treated with extracorporeal membrane oxygenation for acute respiratory distress syndrome. Crit Care Med 2017;45:e500-7. https://doi.org/10.1097/CCM.0000000000002293
  13. Patel JD, Krilov L, Adams S, et al. Clinical cancer advances 2013: annual report on progress against cancer from the American Society of Clinical Oncology. J Clin Oncol 2014;32:129-60.
  14. Sant M, Minicozzi P, Mounier M, et al. Survival for haematological malignancies in Europe between 1997 and 2008 by region and age: results of EUROCARE-5, a population-based study. Lancet Oncol 2014;15:931-42. https://doi.org/10.1016/S1470-2045(14)70282-7
  15. Bird GT, Farquhar-Smith P, Wigmore T, Potter M, Gruber PC. Outcomes and prognostic factors in patients with haematological malignancy admitted to a specialist cancer intensive care unit: a 5 yr study. Br J Anaesth 2012;108: 452-9. https://doi.org/10.1093/bja/aer449
  16. Rhee CK, Kang JY, Kim YH, et al. Risk factors for acute respiratory distress syndrome during neutropenia recovery in patients with hematologic malignancies. Crit Care 2009; 13:R173. https://doi.org/10.1186/cc8149
  17. Bach PB, Schrag D, Nierman DM, et al. Identification of poor prognostic features among patients requiring mechanical ventilation after hematopoietic stem cell transplantation. Blood 2001;98:3234-40. https://doi.org/10.1182/blood.V98.12.3234
  18. Corcia Palomo Y, Knight Asorey T, Espigado I, Martin Villen L, Garnacho Montero J. Mortality of oncohematological patients undergoing hematopoietic stem cell transplantation admitted to the intensive care unit. Transplant Proc 2015;47:2665-6. https://doi.org/10.1016/j.transproceed.2015.09.033
  19. Schmidt M, Brechot N, Combes A. Ten situations in which ECMO is unlikely to be successful. Intensive Care Med 2016;42:750-2. https://doi.org/10.1007/s00134-015-4013-9
  20. Park TS, Oh YN, Hong SB, et al. Extracorporeal membrane oxygenation support in adult patients with hematologic malignancies and severe acute respiratory failure. Korean J Crit Care Med 2016;31:243-50. https://doi.org/10.4266/kjccm.2016.00318
  21. Pulte D, Jansen L, Castro FA, Brenner H. Changes in the survival of older patients with hematologic malignancies in the early 21st century. Cancer 2016;122:2031-40. https://doi.org/10.1002/cncr.30003
  22. Parakh S, Piggin A, Neeman T, Mitchell I, Crispin P, Davis A. Outcomes of haematology/oncology patients admitted to intensive care unit at the Canberra Hospital. Intern Med J 2014;44:1087-94. https://doi.org/10.1111/imj.12545

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