Multicenter Study

. 2024 Nov 1;25(11):1026-1034.

doi: 10.1097/PCC.0000000000003584. Epub 2024 Jul 19.

Pediatric Hematology and Oncology Patients on Extracorporeal Membrane Oxygenation: Outcomes in a Multicenter, Retrospective Cohort, 2009-2021

Michael Colin Mowrer¹, Lisa Lima², Rohit Nair³, Xilong Li⁴, Hitesh Sandhu⁵, Brian Bridges⁶, Ryan P Barbaro⁷, Saleh Bhar⁸, Raymond Nkwantabisa¹, Saad Ghafoor⁹, Agnes Reschke¹⁰, Taylor Olson¹¹, Matthew P Malone¹², Neel Shah¹³, Matt S Zinter¹⁴, Jon Gehlbach¹⁵, Laura Hollinger¹⁶, Briana L Scott¹⁷, Reut Kassif Lerner¹⁸, Thomas V Brogan¹⁹, Lakshmi Raman²⁰, Renee M Potera²¹

Affiliations

¹ Division of Critical Care Medicine, Cook Children's Medical Center, Fort Worth, TX.
² Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA.
³ Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA.
⁴ Peter O'Donnell Jr School of Public Health, UT Southwestern Medical Center, Dallas, TX.
⁵ Department of Pediatrics, Division of Critical Care Medicine, University of Tennessee Health Science Center, Memphis, TN.
⁶ Division of Pediatric Critical Care Medicine, Vanderbilt University, Nashville, TN.
⁷ Division of Critical Care Medicine and Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, MI.
⁸ Divisions of Critical Care Medicine and Hematology Oncology, Pediatric Cell Therapy and Bone Marrow Transplant, Baylor College of Medicine, Texas Children's Hospital, Houston, TX.
⁹ Division of Critical Care Medicine, St. Jude Children's Research Hospital, Memphis, TN.
¹⁰ Department of Pediatric Critical Care Medicine, Stanford University, Palo Alto, CA.
¹¹ Department of Pediatrics, Division of Critical Care Medicine, Children's National Hospital and George Washington University School of Medicine and Health Sciences, Washington, DC.
¹² Department of Pediatrics, Division of Critical Care Medicine, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR.
¹³ Department of Pediatrics, Washington University St. Louis, St. Louis, MO.
¹⁴ Divisions of Critical Care and Bone Marrow Transplantation, Department of Pediatrics, University of California San Francisco, San Francisco, CA.
¹⁵ Division of Pediatric Critical Care Medicine, University of Illinois College of Medicine Peoria, Peoria, IL.
¹⁶ Division of Pediatric Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC.
¹⁷ Division of Critical Care Medicine, University of Rochester Medical Center, Rochester, NY.
¹⁸ Department of Pediatric Intensive Care, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Israel.
¹⁹ Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA.
²⁰ Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX.
²¹ Division of Critical Care Medicine, Phoenix Children's Hospital, Phoenix, AZ.

PMID: 39028213
DOI: 10.1097/PCC.0000000000003584

Multicenter Study

Pediatric Hematology and Oncology Patients on Extracorporeal Membrane Oxygenation: Outcomes in a Multicenter, Retrospective Cohort, 2009-2021

Michael Colin Mowrer et al. Pediatr Crit Care Med. 2024.

. 2024 Nov 1;25(11):1026-1034.

doi: 10.1097/PCC.0000000000003584. Epub 2024 Jul 19.

Authors

Affiliations

¹ Division of Critical Care Medicine, Cook Children's Medical Center, Fort Worth, TX.
² Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA.
³ Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA.
⁴ Peter O'Donnell Jr School of Public Health, UT Southwestern Medical Center, Dallas, TX.
⁵ Department of Pediatrics, Division of Critical Care Medicine, University of Tennessee Health Science Center, Memphis, TN.
⁶ Division of Pediatric Critical Care Medicine, Vanderbilt University, Nashville, TN.
⁷ Division of Critical Care Medicine and Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, MI.
⁸ Divisions of Critical Care Medicine and Hematology Oncology, Pediatric Cell Therapy and Bone Marrow Transplant, Baylor College of Medicine, Texas Children's Hospital, Houston, TX.
⁹ Division of Critical Care Medicine, St. Jude Children's Research Hospital, Memphis, TN.
¹⁰ Department of Pediatric Critical Care Medicine, Stanford University, Palo Alto, CA.
¹¹ Department of Pediatrics, Division of Critical Care Medicine, Children's National Hospital and George Washington University School of Medicine and Health Sciences, Washington, DC.
¹² Department of Pediatrics, Division of Critical Care Medicine, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR.
¹³ Department of Pediatrics, Washington University St. Louis, St. Louis, MO.
¹⁴ Divisions of Critical Care and Bone Marrow Transplantation, Department of Pediatrics, University of California San Francisco, San Francisco, CA.
¹⁵ Division of Pediatric Critical Care Medicine, University of Illinois College of Medicine Peoria, Peoria, IL.
¹⁶ Division of Pediatric Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC.
¹⁷ Division of Critical Care Medicine, University of Rochester Medical Center, Rochester, NY.
¹⁸ Department of Pediatric Intensive Care, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Israel.
¹⁹ Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA.
²⁰ Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX.
²¹ Division of Critical Care Medicine, Phoenix Children's Hospital, Phoenix, AZ.

PMID: 39028213
DOI: 10.1097/PCC.0000000000003584

Abstract

Objective: To describe characteristics associated with survival for pediatric patients with an oncologic diagnosis or hematopoietic cell transplant (HCT) supported with extracorporeal membrane oxygenation (ECMO).

Design: Multicenter, retrospective study.

Setting: Sixteen PICUs in the United States and Israel.

Patients: We included patients aged younger than 19 years with an oncologic diagnosis or HCT who required ECMO support between 2009 and 2021.

Interventions: None.

Measurements and main results: A total of 149 patients were included in the study cohort. There were 118 patients with an oncologic diagnosis and 31 that received HCT. The indications for ECMO were respiratory failure (46%), combined respiratory and cardiac failure (28%), and cardiac failure (25%). Venovenous (V-V) ECMO was used in 45% of patients, with 53% of patients being placed on venoarterial (V-A) ECMO. For oncologic and HCT groups, survival to ECMO decannulation was 52% (62/118) and 64% (20/31), and survival to hospital discharge was 36% (43/118) and 42% (13/31), respectively. After adjusting for other factors, requiring cardiopulmonary resuscitation was associated with greater odds ratio of mortality (3.0 [95% CI, 1.2-7.7]).

Conclusions: Survival to ECMO decannulation of pediatric oncologic and HCT patients in this study was 52-64%, depending upon diagnosis. However, survival to hospital discharge remains poor. Future research should prioritize understanding factors contributing to this survival gap within these patient populations.

PubMed Disclaimer

Conflict of interest statement

Dr. Mowrer received funding from the Extracorporeal Life Support Organization (ELSO). Drs. Nair and Potera’s institutions received funding from ELSO. Dr. Li disclosed work for hire. Dr. Barbaro’s institution received funding from the National Institutes of Health (NIH) (R01 HL153519); they disclosed they are a member of the ELSO Board of Directors and a member of pediatric extracorporeal membrane oxygenation (ECMO); they disclosed off-label use of ECMO. Dr. Barbaro is a board member for the ELSO and reports funding from the NIH (R01 HL153519). Dr. Zinter received support for article research from the NIH. Dr. Nkwantabisa received funding from Medtronic. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

1. Rogerson CM, Rowan CM: Critical care utilization in children with cancer: U.S. pediatric health information system database cohort 2012-2021. Pediatr Crit Care Med. 2024; 25:e52–e58
1. Zinter MS, McArthur J, Duncan C, et al.; Hematopoietic Cell Transplant and Cancer Immunotherapy Subgroup of the PALISI Network: Candidacy for extracorporeal life support in children after hematopoietic cell transplantation: A position paper from the Pediatric Acute Lung Injury and Sepsis Investigators network’s hematopoietic cell transplant and cancer immunotherapy subgroup. Pediatr Crit Care Med. 2022; 23:205–213
1. Randolph AG, Bembea MM, Cheifetz IM, et al.; Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network: Pediatric Acute Lung Injury and Sepsis Investigators (PALISI): Evolution of an investigator-initiated research network. Pediatr Crit Care Med. 2022; 23:1056–1066
1. Suzuki Y, Cass SH, Kugelmann A, et al.: Outcome of extracorporeal membrane oxygenation for pediatric patients with neoplasm: An extracorporeal life support organization database study (2000-2019). Pediatr Crit Care Med. 2022; 23:e240–e248
1. Harris PA, Taylor R, Thielke R, et al.: Research Electronic Data Capture (REDCap®)—a metadata-driven methodology and workflow process for providing translation research informatics support. J Biomed Inform. 2009; 42:377–381

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Grants and funding

R01 HL153519/HL/NHLBI NIH HHS/United States

LinkOut - more resources

Full Text Sources
Medical
- MedlinePlus Health Information
Miscellaneous
- NCI CPTAC Assay Portal

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Pediatric Hematology and Oncology Patients on Extracorporeal Membrane Oxygenation: Outcomes in a Multicenter, Retrospective Cohort, 2009-2021

Affiliations

Pediatric Hematology and Oncology Patients on Extracorporeal Membrane Oxygenation: Outcomes in a Multicenter, Retrospective Cohort, 2009-2021

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous