Extracorporeal life support for support of children with malignancy and respiratory or cardiac failure: The extracorporeal life support experience.
BACKGROUND
Extracorporeal life support (ECLS) is a means of respiratory and hemodynamic support for patients failing conventional therapies. Children with cancer who develop complications during therapy may require ECLS.


METHODS
The extracorporeal life support organization (ELSO) registry was queried for all patients younger than 21 years with an International Classification of Diseases, Ninth Revision diagnosis of neoplasm. ELSO centers were also asked whether patients with neoplasms should be offered ECLS.


RESULTS
From 1994 to 2007, 107 children met inclusion criteria: 73 with hematologic malignancies and 34 with solid tumors. The median age was 3.71 years. Patients had a total of 112 ECLS runs (five patients had two runs). Patients required ECLS primarily for pulmonary support (n = 86). Median duration of ECLS was 6.1 days. Overall, 62 of 107 patients (58%) died while on ECLS because of irreversible organ failure (n = 37), diagnosis incompatible with life (n = 11), hemorrhage (n = 6), and family request (n = 8). Forty-five of 107 patients (42%) survived ECLS. During the remaining hospitalization, eight patients died resulting in 37 of 107 surviving to hospital discharge (35%). Risk factors for death included lower Po2 before ECLS, higher oxygen index, higher positive end-expiratory pressure, and development of renal or cardiopulmonary complications (p < 0.05). No differences in outcomes were noted in patients with either hematologic malignancies or solid tumors. One hundred eighteen of 133 eligible ECLS centers responded to the questionnaire for an 89% response rate. Among those who responded, 112 of 133 would consider placing a child (95%) with a neoplasm on ECLS.


CONCLUSIONS
Children with cancer and respiratory failure can be offered ECLS with a reasonable expectation for survival. The opinions of the ELSO center suggest that decisions to offer ECLS to a child with malignancy should be made on a case by case basis, with prognosis of the malignancy being an important factor.
Gow
Kenneth W
KW
Department of Surgery, Division of Pediatric Surgery, Emory University, Atlanta, GA, USA. kenneth.gow@seattlechildrens.org
Heiss
Kurt F
KF
Wulkan
Mark L
ML
Katzenstein
Howard M
HM
Rosenberg
Eli S
ES
Heard
Michael L
ML
Rycus
Peter T
PT
Fortenberry
James D
JD
D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000628:therapy*; D006801:Humans; D007223:Infant; D008020:Life Support Care / Q000379:methods*; D008297:Male; D009369:Neoplasms / Q000150:complications; D012131:Respiratory Insufficiency / Q000150:complications / Q000628:therapy*