Real world data: Survival outcomes and risk factors in extracorporeal membrane oxygenation use of cancer patient

Abstract

Background/purpose: Extracorporeal membrane oxygenation (ECMO) is a vital therapy for cardiopulmonary failure, yet its use in patients with cancer remains controversial due to immunosuppression and coagulopathy. Advances in oncology necessitate re-evaluating ECMO's role in this population. This study investigates survival outcomes and prognostic factors in ECMO patients with and without cancer.

Methods: We analyzed a retrospective cohort of 342 adult ECMO patients treated at National Taiwan University Hospital Hsin-chu Branch between January 2017 to December 2023. Patient demographics, medical history, and pre-ECMO laboratory parameters were assessed. Kaplan-Meier curves and Cox proportional hazards models were used to identify survival predictors.

Results: Among the 342 patients, 40 had cancer, with solid tumors constituting 92.5% of cases. 90-day mortality were 56.8% for non-cancer patients and 70.0% for cancer patients, with no significant difference (p = 0.087). Hyperlactatemia (>10 mmol/L, HR: 2.74, p < 0.001) and hypoalbuminemia (< 2.4 g/dL, HR: 1.76, p = 0.018) were significantly associated with worse survival outcomes in the multivariable analysis. Cancer status was not statistically significant (HR: 1.41, p = 0.114). Subgroup analyses in cancer patients confirmed elevated lactate (>10 mmol/L, HR: 8.85, p < 0.001) and low albumin (< 3.4 g/dL, HR: 3.62, p = 0.018) as significant prognostic factors.

Conclusions: ECMO may be an option in highly selected patients with solid tumors and without significant metabolic derangements. Elevated lactate and low albumin predict poor outcomes, highlighting the need for early metabolic optimization. ECMO is a potential bridge therapy for critically ill cancer patients, warranting further validation and assessment of the impact of modern oncologic therapies on outcomes. Only three patients in this study had hematologic malignancies. Therefore, the findings primarily reflect outcomes in patients with solid tumors and should not be generalized to those with hematologic cancers.