Extracorporeal membrane oxygenation in adult patients with hematologic malignancies and severe acute respiratory failure.
BACKGROUND
Acute respiratory failure (ARF) is the main reason for intensive care unit (ICU) admissions in patients with hematologic malignancies (HMs). We report the first series of adult patients with ARF and HMs treated with extracorporeal membrane oxygenation (ECMO).


METHODS
This is a retrospective cohort study of 14 patients with HMs (aggressive non-Hodgkin lymphoma (NHL) n = 5; highly aggressive NHL, that is acute lymphoblastic leukemia or Burkitt lymphoma, n = 5; Hodgkin lymphoma, n = 2; acute myeloid leukemia, n = 1; multiple myeloma, n = 1) receiving ECMO support because of ARF (all data as medians and interquartile ranges; age, 32 years (22 to 51 years); simplified acute physiology score II (SAPS II): 51 (42 to 65)). Etiology of ARF was pneumonia (n = 10), thoracic manifestation of NHL (n = 2), sepsis of nonpulmonary origin (n = 1), and transfusion-related acute lung injury (n = 1). Diagnosis of HM was established during ECMO in four patients, and five first received (immuno-) chemotherapy on ECMO.


RESULTS
Before ECMO, the PaO2/FiO2 ratio was 60 (53 to 65), (3.3 to 3.7). Three patients received venoarterial ECMO because of acute circulatory failure in addition to ARF; all other patients received venovenous ECMO. All patients needed vasopressors, and five needed hemofiltration. Thrombocytopenia occurred in all patients (lowest platelet count was 20 (11 to 21) G/L). Five major bleeding events were noted. ECMO duration was 8.5 (4 to 16) days. ICU and hospital survival was 50%. All survivors were alive at follow-up (36 (10 to 58) months); five patients were in complete remission, one in partial remission, and one had relapsed.


CONCLUSIONS
ECMO therapy is feasible in selected patients with HMs and ARF and can be associated with long-term disease-free survival.
Philipp
P
Wohlfarth
Roman
R
Ullrich
Thomas
T
Staudinger
Andja
A
Bojic
Oliver
O
Robak
Alexander
A
Hermann
Barbara
B
Lubsczyk
Nina
N
Worel
Valentin
V
Fuhrmann
Maria
M
Schoder
Martin
M
Funovics
Werner
W
Rabitsch
Paul
P
Knoebl
Klaus
K
Laczika
Gottfried J
GJ
Locker
Wolfgang R
WR
Sperr
Peter
P
Schellongowski
D000328:Adult; D015331:Cohort Studies; D015199:Extracorporeal Membrane Oxygenation / Q000401:mortality / Q000639:trends*; D005260:Female; D019337:Hematologic Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007362:Intensive Care Units / Q000639:trends; D008297:Male; D008875:Middle Aged; D012128:Respiratory Distress Syndrome / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D055815:Young Adult