title: The feasibility of venovenous extracorporeal life support to treat acute respiratory failure in adult cancer patients.
abstract: Venovenous extracorporeal life support (VV-ECLS) is a lifesaving but invasive treatment for acute respiratory failure (ARF) that is not improved with conventional therapy. However, using VV-ECLS to treat ARF in adult cancer patients is controversial. This retrospective study included 14 cancer patients (median age: 58 years [interquartile range: 51-66]; solid malignancies in 13 patients and hematological malignancy in 1 patient) who received VV-ECLS for ARF that developed within 3 months after anticancer therapies. VV-ECLS would be considered in selected patients with a P(a)O2/F(i)O2 ratio ≤70 mmHg under advanced mechanical ventilation. Before ECLS, the medians of intubation day, P(a)O2/F(i)O2 ratio, and Sequential Organ Failure Assessment (SOFA) score were 8 (2-12), 62 mmHg (53-76), and 10 (9-14), respectively. The case numbers of bacteremia, thrombocytopenia (platelet count <50000 cells/μL), and neutropenia (actual neutrophil count <1000 cells/μL) detected before ECLS were 3 (21%), 2 (14%), and 1 (7%), respectively. After 24 hours of ECLS, a significant improvement was seen in P(a)O2/F(i)O2 ratio but not in SOFA score. Six patients experienced major hemorrhages during ECLS. The median ECLS day, ECLS weaning rate, and hospital survival were 11 (7-16), 50% (n = 7), and 29% (n = 4). The development of dialysis-dependent nephropathy predicted death on ECLS (odds ratio: 36; 95% confidence interval: 1.8-718.7; P = 0.01). With a median follow-up of 11 (6-43) months, half of the survivors died of cancer recurrence and the others were in partial remission. The most prominent benefit of VV-ECLS is to improve the arterial oxygenation and rest the lungs. This may increase the chance of recovery from ARF in selected cancer patients.
authors.affiliation: From the Department of Cardiovascular Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan (M-YW, Y-HT, Y-SC, P-JL); Department of Obstetrics and Gynecology, Wan Fang Hospital, Taipei Medical University, Taipei (T-IW); Department of Hematology-Oncology (W-CS); and Department of Thoracic Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (C-CH).
authors.forename: Meng-Yu
authors.initials: MY
authors.lastname: Wu
authors.forename: Tzu-I
authors.initials: TI
authors.lastname: Wu
authors.forename: Yuan-His
authors.initials: YH
authors.lastname: Tseng
authors.forename: Wen-Chi
authors.initials: WC
authors.lastname: Shen
authors.forename: Yu-Sheng
authors.initials: YS
authors.lastname: Chang
authors.forename: Chung-Chi
authors.initials: CC
authors.lastname: Huang
authors.forename: Pyng-Jing
authors.initials: PJ
authors.lastname: Lin
mesh_terms: D000368:Aged; D005112:Extracorporeal Circulation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D063305:Organ Dysfunction Scores; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000628:therapy*; D012189:Retrospective Studies