Acute Crit Care.  2024 Feb;39(1):108-116. 10.4266/acc.2023.01088.

Outcomes of extracorporeal membrane oxygenation support in pediatric hemato-oncology patients

Affiliations
  • 1Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
  • 2Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea

Abstract

Background
In this study, we reviewed the outcomes of pediatric patients with malignancies who underwent hematopoietic stem cell transplantation (HSCT) and extracorporeal membrane oxygenation (ECMO). Methods: We retrospectively analyzed the records of pediatric hemato-oncology patients treated with chemotherapy or HSCT and who received ECMO in the pediatric intensive care unit (PICU) at Seoul National University Children’s Hospital from January 2012 to December 2020. Results: Over a 9-year period, 21 patients (14 males and 7 females) received ECMO at a single pediatric institute; 10 patients (48%) received veno-arterial (VA) ECMO for septic shock (n=5), acute respiratory distress syndrome (ARDS) (n=3), stress-induced myopathy (n=1), or hepatopulmonary syndrome (n=1); and 11 patients (52%) received veno-venous (VV) ECMO for ARDS due to pneumocystis pneumonia (n=1), air leak (n=3), influenza (n=1), pulmonary hemorrhage (n=1), or unknown etiology (n=5). All patients received chemotherapy; 9 received anthracycline drugs and 14 (67%) underwent HSCT. Thirteen patients (62%) were diagnosed with malignancies and 8 (38%) were diagnosed with non-malignant disease. Among the 21 patients, 6 (29%) survived ECMO in the PICU and 5 (24%) survived to hospital discharge. Among patients treated for septic shock, 3 of 5 patients (60%) who underwent ECMO and 5 of 10 patients (50%) who underwent VA ECMO survived. However, all the patients who underwent VA ECMO or VV ECMO for ARDS died. Conclusions: ECMO is a feasible treatment option for respiratory or heart failure in pediatric patients receiving chemotherapy or undergoing HSCT.

Keyword

extracorporeal membrane oxygenation; hematopoietic stem cell transplantation; intensive care unit, pediatrics; neoplasm

Figure

  • Figure 1. (A) Kaplan-Meier survival curve of extracorporeal membrane oxygenation support (ECMO). (B) Comparison between veno-arterial (VA) ECMO and veno-venous (VV) ECMO. (C) Comparison between viral infection. (D) Comparison between Bleeding event.


Reference

1. Zabrocki LA, Brogan TV, Statler KD, Poss WB, Rollins MD, Bratton SL. Extracorporeal membrane oxygenation for pediatric respiratory failure: survival and predictors of mortality. Crit Care Med. 2011; 39:364–70.
Article
2. von Bahr V, Hultman J, Eksborg S, Gerleman R, Enstad Ø, Frenckner B, et al. Long-term survival and causes of late death in children treated with extracorporeal membrane oxygenation. Pediatr Crit Care Med. 2017; 18:272–80.
Article
3. Jenks CL, Raman L, Dalton HJ. Pediatric extracorporeal membrane oxygenation. Crit Care Clin. 2017; 33:825–41.
Article
4. Coleman RD, Goldman J, Moffett B, Guffey D, Loftis L, Thomas J, et al. Extracorporeal membrane oxygenation mortality in high-risk populations: an analysis of the pediatric health information system database. ASAIO J. 2020; 66:327–31.
Article
5. Slooff V, Hoogendoorn R, Nielsen JS, Pappachan J, Amigoni A, Caramelli F, et al. Role of extracorporeal membrane oxygenation in pediatric cancer patients: a systematic review and meta-analysis of observational studies. Ann Intensive Care. 2022; 12:8.
Article
6. Gupta M, Shanley TP, Moler FW. Extracorporeal life support for severe respiratory failure in children with immune compromised conditions. Pediatr Crit Care Med. 2008; 9:380–5.
Article
7. Gow KW, Heiss KF, Wulkan ML, Katzenstein HM, Rosenberg ES, Heard 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; 37:1308–16.
Article
8. Leahey AM, Bunin NJ, Schears GJ, Smith CA, Flake AW, Sullivan KE. Successful use of extracorporeal membrane oxygenation (ECMO) during BMT for SCID. Bone Marrow Transplant. 1998; 21:839–40.
Article
9. Fan K, Hurley C, McNeil MJ, Agulnik A, Federico S, Qudeimat A, et al. Case report: management approach and use of extracorporeal membrane oxygenation for diffuse alveolar hemorrhage after pediatric hematopoietic cell transplant. Front Pediatr. 2020; 8:587601.
Article
10. Kebudi R, Oflaz Sozmen B, Bahar M, Paker T, Hacı I, Ekinci A, et al. Prolonged extracorporeal membrane oxygenation in pediatric leukemia with severe acute respiratory distress syndrome and persistent fungemia. Pediatr Blood Cancer. 2021; 68:e28966.
Article
11. Prabhu AD, Mos K, Karl TR, Anderson B. Extracorporeal life support in the acute management of tumour lysis syndrome. Interact Cardiovasc Thorac Surg. 2012; 15:568–9.
Article
12. Olson TL, O'Neil ER, Kurtz KJ, MacLaren G, Anders MM. Improving outcomes for children requiring extracorporeal membrane oxygenation therapy following hematopoietic stem cell transplantation. Crit Care Med. 2021; 49:e381–93.
Article
13. Suzuki Y, Kugelmann A, Cass S, Radhakrishnan R. Extracorporeal membrane oxygenation for pediatric patients with malignancy: outcomes and trends in the last decade. J Am Coll Surg. 2021; 233:S293–4.
Article
14. Potratz JC, Guddorf S, Ahlmann M, Tekaat M, Rossig C, Omran H, et al. Extracorporeal membrane oxygenation in children with cancer or hematopoietic cell transplantation: single-center experience in 20 consecutive patients. Front Oncol. 2021; 11:664928.
Article
15. Ranta S, Kalzén H, Nilsson A, von Schewelov K, Broman LM, Berner J, et al. Extracorporeal membrane oxygenation support in children with hematologic malignancies in Sweden. J Pediatr Hematol Oncol. 2021; 43:e272–5.
Article
16. Cortina G, Neu N, Kropshofer G, Meister B, Klingkowski U, Crazzolara R. Extracorporeal membrane oxygenation offers long-term survival in childhood leukemia and acute respiratory failure. Crit Care. 2018; 22:222.
Article
17. Steppan DA, Coleman RD, Viamonte HK, Hanson SJ, Carroll MK, Klein OR, et al. Outcomes of pediatric patients with oncologic disease or following hematopoietic stem cell transplant supported on extracorporeal membrane oxygenation: the PEDECOR experience. Pediatr Blood Cancer. 2020; 67:e28403.
Article
18. Kang HS, Rhee CK, Lee HY, Kim YK, Kwon SS, Kim SC, et al. Clinical outcomes of extracorporeal membrane oxygenation support in patients with hematologic malignancies. Korean J Intern Med. 2015; 30:478–88.
Article
19. Di Nardo M, Ahmad AH, Merli P, Zinter MS, Lehman LE, Rowan CM, et al. Extracorporeal membrane oxygenation in children receiving haematopoietic cell transplantation and immune effector cell therapy: an international and multidisciplinary consensus statement. Lancet Child Adolesc Health. 2022; 6:116–28.
Article
20. Di Nardo M, MacLaren G, Schellongowski P, Azoulay E, DeZern AE, Gutierrez C, et al. Extracorporeal membrane oxygenation in adults receiving haematopoietic cell transplantation: an international expert statement. Lancet Respir Med. 2023; 11:477–92.
Article
21. Smith S, Butt W, Best D, MacLaren G. Long-term survival after extracorporeal life support in children with neutropenic sepsis. Intensive Care Med. 2016; 42:942–3.
Article
22. Di Nardo M, Locatelli F, Palmer K, Amodeo A, Lorusso R, Belliato M, 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; 40:754–6.
Article
23. Gow KW, Wulkan ML, Heiss KF, Haight AE, Heard ML, Rycus P, et al. Extracorporeal membrane oxygenation for support of children after hematopoietic stem cell transplantation: the Extracorporeal Life Support Organization experience. J Pediatr Surg. 2006; 41:662–7.
Article
Full Text Links
  • ACC
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr