Extracorporeal Life Support in Adult Patients with Hematologic Malignancies and Acute Circulatory and/or Respiratory Failure

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.

Keywords: Adult; Extracorporeal membrane oxygenation; Hematologic neoplasms; Mortality.

Fig. 1

Treatment algorithm and outcomes. ECMO, extracorporeal membrane oxygenation; V-A, veno-arterial; V-V, veno-venous; ICU, intensive care unit.

Fig. 2

Age (A) and BUN levels at ECMO initiation (B) in patients weaned from ECMO were significantly lower than in those who were not weaned from ECMO in the univariate analysis (age: p=0.03; BUN: p=0.03) in a logistic regression model. ECMO, extracorporeal membrane oxygenation.