Korean J Crit Care Med.  2016 Aug;31(3):243-250. 10.4266/kjccm.2016.00318.

Extracorporeal Membrane Oxygenation Support in Adult Patients with Hematologic Malignancies and Severe Acute Respiratory Failure

• Park TS
• Oh YN
• Hong SB
• Lim CM
• Koh Y
• Lee JH
• Lee JH
• Lee KH
• Huh JW

• KMID: 2350909
• DOI: http://doi.org/10.4266/kjccm.2016.00318

Abstract

BACKGROUND
Administering extracorporeal membrane oxygenation (ECMO) to critically ill patients with acute respiratory distress syndrome has substantially increased over the last decade, however administering ECMO to patients with hematologic malignancies may carry a particularly high risk. Here, we report the clinical outcomes of patients with hematologic malignancies and severe acute respiratory failure who were treated with ECMO.
METHODS
We performed a retrospective review of the medical records of patients with hematologic malignancies and severe acute respiratory failure who were treated with ECMO at the medical intensive care unit of a tertiary referral hospital between March 2010 and April 2015.
RESULTS
A total of 15 patients (9 men; median age 45 years) with hematologic malignancies and severe acute respiratory failure received ECMO therapy during the study period. The median values of the Acute Physiology and Chronic Health Evaluation II score, Murray Lung Injury Score, and Respiratory Extracorporeal Membrane Oxygenation Survival Prediction Score were 29, 3.3, and -2, respectively. Seven patients received venovenous ECMO, whereas 8 patients received venoarterial ECMO. The median ECMO duration was 2 days. Successful weaning of ECMO was achieved in 3 patients. Hemorrhage complications developed in 4 patients (1 pulmonary hemorrhage, 1 intracranial hemorrhage, and 2 cases of gastrointestinal bleeding). The longest period of patient survival was 59 days after ECMO initiation. No significant differences in survival were noted between venovenous and venoarterial ECMO groups (10.0 vs. 10.5 days; p = 0.56).
CONCLUSIONS
Patients with hematologic malignancies and severe acute respiratory failure demonstrate poor outcomes after ECMO treatment. Careful and appropriate selection of candidates for ECMO in these patients is necessary.

Keyword

hematologic neoplasms; extracorporeal membrane oxygenation; respiratory insufficiency

MeSH Terms

Adult*
APACHE
Critical Illness
Extracorporeal Membrane Oxygenation*
Hematologic Neoplasms*
Hemorrhage
Humans
Intensive Care Units
Intracranial Hemorrhages
Lung Injury
Male
Medical Records
Respiratory Distress Syndrome, Adult
Respiratory Insufficiency*
Retrospective Studies
Tertiary Care Centers
Weaning

Figure

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  Fig. 1. Kaplan-Meier survival analysis of the study patients with hematological malignancies and severe acute respiratory failure. The median survival period was 10 days after ECMO initiation. ECMO: extracorporeal membrane oxygenation.

Reference

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