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. 2025 Sep 25.
doi: 10.1007/s00134-025-08113-7. Online ahead of print.

Acute respiratory distress syndrome in patients with cancer: the YELENNA prospective multinational observational cohort study

Peter Schellongowski  1 , Michael Darmon  2 , Philipp Eller  3 , Laveena Munshi  4 , Tobias Liebregts  5 , Victoria Metaxa  6 , Luca Montini  7 , Tobias Lahmer  8 , Fabio S Taccone  9 , Andry van de Louw  10 , Martin Balik  11 , Peter Pickkers  12 , Pleun Hemelaar  12 , Hemang Yadav  13 , Andreas Barratt-Due  14   15 , Thomas Karvunidis  16 , Jordi Riera  17 , Gennaro Martucci  18 , Ignacio Martin-Loeches  19   20 , Pedro Castro  21 , Nina Buchtele  22 , Virginie Lemiale  2 , Stefan Hatzl  3 , Guillaume Dumas  4 , Thomas Staudinger  22 , Elie Azoulay  2 ; YELENNA Investigators and the Nine-I Study Group
Collaborators, Affiliations

Acute respiratory distress syndrome in patients with cancer: the YELENNA prospective multinational observational cohort study

Peter Schellongowski et al. Intensive Care Med. .

Abstract

Purpose: Acute respiratory failure is the leading reason for intensive care unit (ICU) admission among critically ill patients with cancer. We aimed to describe the clinical characteristics, risk factors, and outcomes of patients with cancer and acute respiratory distress syndrome (ARDS) and to evaluate associations of venovenous extracorporeal membrane oxygenation (ECMO) with outcomes in the subgroup with severe ARDS.

Methods: We conducted a multinational, prospective, observational cohort study of patients with cancer and ARDS in 13 countries in Europe and North America. The primary endpoint was 90-day mortality.

Results: Among 715 included patients, 73.4% had hematologic malignancies and 26.6% solid tumors; 31.2% had undergone hematopoietic stem-cell transplantation (168 allogeneic). ICU, hospital, and 90-day mortality rates were 55.3%, 70.9%, and 73.2%, respectively. By multivariate analysis, independent predictors of higher 90-day mortality were older age, peripheral vascular disease, severe ARDS at inclusion, acute kidney injury, and ICU admission as a time-limited trial (vs. full code). Conversely, lymphoma was associated with lower 90-day mortality. Among the 322 patients (45.7%) with severe ARDS at inclusion, 90-day mortality was 82.2%; with no difference between patients who received ECMO (n = 58, 18%) and those who did not (82.6% vs. 80.7%, P = 0.89). This finding remained unchanged in a double-adjusted overlap- and propensity-weighted Cox mixed-effects model (adjusted hazard ratio, 1.12; 95% confidence interval 0.65-1.94; P = 0.69).

Conclusion: Patients with cancer and ARDS, particularly severe forms, experience high 90-day mortality, irrespective of ECMO use. These findings suggest a need for nuanced ICU goals-of-care discussions and raise concerns about the generalizability of ECMO guidelines to this population.

Keywords: Ards; Cancer; Ecmo; Leukemia; Lymphoma; Outcome.

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Conflict of interest statement

Declarations. Conflicts of interest: PS reports speaker fees from Fresenius Medical and Getinge; MD reports payments to his institution made by Gilead; TS reports speaker fees from Baxter, CSL Behring, Fresenius Medical, Getinge, and Mitsubishi Pharma; VL reports being the treasurer of a research group (GrrrOh), which received payments from Alexion, Fisher Paykel, Gilead, Sanofi, and Shionogi; all other authors did not report any conflicts of interest. MD and VM are Section Editors for Intensive Care Medicine. They have not taken part in the review or selection process of this article. Ethics approval: Institutional review board approval was obtained by each participating ICU in accordance with local ethics regulations. Written informed consent was obtained from each patient, or from a relative if the patient was too ill to provide consent, before study inclusion.

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