Aims: The acute respiratory distress syndrome (ARDS) is a frequent condition following pneumonia in immunocompromised cancer patients. Extracorporeal membrane oxygenation (ECMO) may serve as a rescue therapy in refractory ARDS but has still not been studied in predominantly leuco- and thrombocytopenic cancer patients. Patients and Methods: In this monocentric, retrospective, observational study, we assessed all cancer patients treated with ECMO for ARDS between 2013 and 2017. Results: 25 patients, 11 of whom underwent haematopoietic stem cell transplantation (SCT), were analysed. The main reason for ARDS was pneumonia in 72%. All patients were under invasive ventilation at ECMO. All but 9/3 patients suffered from leuco-/thrombocytopenia due to anti-cancer treatment or underlying disease. Overall, 17 patients (68%) died on ECMO, whereas 5 patients survived to hospital discharge (20%). All patients after recent allogeneic (allo-)SCT have died. 4 patients experienced severe bleeding events. Conclusions: Discouraging survival rates in patients treated after allo-SCT do not support the use of ECMO for ARDS in this patient subgroup. On the contrary, cancer patients in at least stable disease otherwise eligible for full-code intensive care unit management, even those with severe thrombocytopenia, may be potential candidates for ECMO in case of severe ARDS failing conventional measures.

Keywords:
Extracorporeal membrane oxygenation (ECMO), Cancer patients, Leucopenia, Thrombocytopenia, Feasibility
1.
Yadav H, Nolan ME, Bohman JK, et al.: Epidemiology of acute respiratory distress syndrome following hematopoietic stem cell transplantation. Crit Care Med 2016;44:1082-1090.
2.
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.
3.
Azoulay E, Lemiale V, Mokart D, et al.: Acute respiratory distress syndrome in patients with malignancies. Intensive Care Med 2014;40:1106-1114.
4.
Mokart D, van Craenenbroeck T, Lambert J, et al.: Prognosis of acute respiratory distress syndrome in neutropenic cancer patients. Eur Respir J 2012;40:169-176.
5.
Lecuyer L, Chevret S, Thiery G, et al.: The ICU trial: a new admission policy for cancer patients requiring mechanical ventilation. Crit Care Med 2007;35:808-814.
6.
Guerin C, Reignier J, Richard JC, et al.: Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 2013;368:2159-2168.
7.
Peek GJ, Clemens F, Elbourne D, et al.: CESAR: conventional ventilatory support vs extracorporeal membrane oxygenation for severe adult respiratory failure. BMC Health Serv Res 2006;6:163.
8.
Noah MA, Peek GJ, Finney SJ, et al.: Referral to an extracorporeal membrane oxygenation center and mortality among patients with severe 2009 influenza A(H1N1). JAMA 2011;306:1659-1668.
9.
Gow KW, Heiss KF, Wulkan ML, et al.: Extracorporeal life support for support of children with malignancy and respiratory or cardiac failure: the extracorporeal life support experience. Crit Care Med 2009;37:1308-1316.
10.
Gow KW, Wulkan ML, Heiss KF, et al.: Extracorporeal membrane oxygenation for support of children after hematopoietic stem cell transplantation: the Extracorporeal Life Support Organization experience. J Pediatr Surg 2006;41:662-667.
11.
Di Nardo M, Locatelli F, Palmer K, et al.: Extracorporeal membrane oxygenation in pediatric recipients of hematopoietic stem cell transplantation: an updated analysis of the Extracorporeal Life Support Organization experience. Intensive Care Med 2014;40:754-756.
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-e507.
13.
Force ADT, Ranieri VM, Rubenfeld GD, et al.: Acute respiratory distress syndrome: the Berlin Definition. JAMA 2012;307:2526-2533.
15.
Meduri GU, Headley AS, Golden E, et al.: Effect of prolonged methylprednisolone therapy in unresolving acute respiratory distress syndrome: a randomized controlled trial. JAMA 1998;280:159-165.
16.
Schulman S, Angeras U, Bergqvist D, et al.: Definition of major bleeding in clinical investigations of antihemostatic medicinal products in surgical patients. J Thromb Haemost 2010;8:202-204.
17.
Azoulay E, Mokart D, Pene F, et al.: Outcomes of critically ill patients with hematologic malignancies: prospective multicenter data from France and Belgium - a Groupe de recherche respiratoire en reanimation onco-hematologique study. J Clin Oncol 2013;31: 2810-2818.
18.
Molina R, Bernal T, Borges M, et al.: Ventilatory support in critically ill hematology patients with respiratory failure. Crit Care 2012;16:R133.
19.
Taccone FS, Artigas AA, Sprung CL, et al.: Characteristics and outcomes of cancer patients in European ICUs. Crit Care 2009;13:R15.
20.
Liao WI, Tsai SH, Chiu SK: Successful use of extracorporeal membrane oxygenation in a hematopoietic stem cell transplant patient with idiopathic pneumonia syndrome. Respir Care 2013;58:e6-e10.
21.
Stretch R, Bonde P: Successful use of extracorporeal membrane oxygenation for respiratory failure in pulmonary chronic graft-versus-host disease. ASAIO J 2014;60:122-123.
22.
Lueck C, Kuehn C, Hoeper MM, et al.: Successful use of extracorporeal membrane oxygenation during induction chemotherapy in a patient with mediastinal tumor mass of a T lymphoblastic lymphoma. Ann Hematol 2016;95:1719-1721.
23.
Shah A, Pasrija C, Kronfli A, et al.: Veno-venous extracorporeal membrane oxygenation use in the treatment of bleomycin pulmonary toxicity. Innovations (Phila) 2017;12:144-146.
24.
Choi KB, Kim HW, Jo KH, et al.: Extracorporeal life support in patients with hematologic malignancies: a single center experience. Korean J Thorac Cardiovasc Surg 2016;49:280-286.
25.
Vaquer S, de Haro C, Peruga P, et al.: Systematic review and meta-analysis of complications and mortality of veno-venous extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome. Ann Intensive Care 2017;7:51.
26.
Kreyer S, Muders T, Theuerkauf N, et al.: Hemorrhage under veno-venous extracorporeal membrane oxygenation in acute respiratory distress syndrome patients: a retrospective data analysis. J Thorac Dis 2017;9:5017-5029.
27.
Panigada M, E Iapichino G, Brioni M, et al.: Thromboelastography-based anticoagulation management during extracorporeal membrane oxygenation: a safety and feasibility pilot study. Ann Intensive Care 2018; 8:7.
28.
Krueger K, Schmutz A, Zieger B, et al.: Venovenous extracorporeal membrane oxygenation with prophylactic subcutaneous anticoagulation only: an observational study in more than 60 patients. Artif Organs 2017;41:186-192.
© 2018 S. Karger GmbH, Freiburg
2018
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.