Extracorporeal membrane oxygenation in adults receiving haematopoietic cell transplantation: an international expert statement

TY - JOUR

T1 - Extracorporeal membrane oxygenation in adults receiving haematopoietic cell transplantation: an international expert statement

AU - Di Nardo, Matteo

AU - MacLaren, Graeme

AU - Schellongowski, Peter

AU - Azoulay, Elie

AU - DeZern, Amy E

AU - Gutierrez, Cristina

AU - Antonelli, Massimo

AU - Antonini, Marta V

AU - Beutel, Gernot

AU - Combes, Alain

AU - Diaz, Rodrigo

AU - Fawzy Hassan, Ibrahim

AU - Fowles, Jo-Anne

AU - Jeong, In-Seok

AU - Kochanek, Matthias

AU - Liebregts, Tobias

AU - Lueck, Catherina

AU - Pediatrics, Palliative and Supportive Care Section, The University of Texas MD Anderson Cancer Center, Houston, TX, USA, Division

AU - Moore, Jessica A

AU - Munshi, Laveena

AU - Paden, Matthew

AU - Pène, Frédéric

AU - Puxty, Kathryn

AU - Schmidt, Matthieu

AU - Staudacher, Dawid

AU - Staudinger, Thomas

AU - Stemmler, Joachim

AU - Stephens, R Scott

AU - Vande Vusse, Lisa

AU - Wohlfarth, Philipp

AU - Lorusso, Roberto

AU - Amodeo, Antonio

AU - Mahadeo, Kris M

AU - Brodie, Daniel

AU - European Society of Intensive Care Medicine, the International ECMO Network, and the Extracorporeal Life Support Organization

N1 - Copyright © 2023 Elsevier Ltd. All rights reserved.

PY - 2023/5

Y1 - 2023/5

N2 - Combined advances in haematopoietic cell transplantation (HCT) and intensive care management have improved the survival of patients with haematological malignancies admitted to the intensive care unit. In cases of refractory respiratory failure or refractory cardiac failure, these advances have led to a renewed interest in advanced life support therapies, such as extracorporeal membrane oxygenation (ECMO), previously considered inappropriate for these patients due to their poor prognosis. Given the scarcity of evidence-based guidelines on the use of ECMO in patients receiving HCT and the need to provide equitable and sustainable access to ECMO, the European Society of Intensive Care Medicine, the Extracorporeal Life Support Organization, and the International ECMO Network aimed to develop an expert consensus statement on the use of ECMO in adult patients receiving HCT. A steering committee with expertise in ECMO and HCT searched the literature for relevant articles on ECMO, HCT, and immune effector cell therapy, and developed opinion statements through discussions following a Quaker-based consensus approach. An international panel of experts was convened to vote on these expert opinion statements following the Research and Development/University of California, Los Angeles Appropriateness Method. The Appraisal of Guidelines for Research and Evaluation statement was followed to prepare this Position Paper. 36 statements were drafted by the steering committee, 33 of which reached strong agreement after the first voting round. The remaining three statements were discussed by all members of the steering committee and expert panel, and rephrased before an additional round of voting. At the conclusion of the process, 33 statements received strong agreement and three weak agreement. This Position Paper could help to guide intensivists and haematologists during the difficult decision-making process regarding ECMO candidacy in adult patients receiving HCT. The statements could also serve as a basis for future research focused on ECMO selection criteria and bedside management.

AB - Combined advances in haematopoietic cell transplantation (HCT) and intensive care management have improved the survival of patients with haematological malignancies admitted to the intensive care unit. In cases of refractory respiratory failure or refractory cardiac failure, these advances have led to a renewed interest in advanced life support therapies, such as extracorporeal membrane oxygenation (ECMO), previously considered inappropriate for these patients due to their poor prognosis. Given the scarcity of evidence-based guidelines on the use of ECMO in patients receiving HCT and the need to provide equitable and sustainable access to ECMO, the European Society of Intensive Care Medicine, the Extracorporeal Life Support Organization, and the International ECMO Network aimed to develop an expert consensus statement on the use of ECMO in adult patients receiving HCT. A steering committee with expertise in ECMO and HCT searched the literature for relevant articles on ECMO, HCT, and immune effector cell therapy, and developed opinion statements through discussions following a Quaker-based consensus approach. An international panel of experts was convened to vote on these expert opinion statements following the Research and Development/University of California, Los Angeles Appropriateness Method. The Appraisal of Guidelines for Research and Evaluation statement was followed to prepare this Position Paper. 36 statements were drafted by the steering committee, 33 of which reached strong agreement after the first voting round. The remaining three statements were discussed by all members of the steering committee and expert panel, and rephrased before an additional round of voting. At the conclusion of the process, 33 statements received strong agreement and three weak agreement. This Position Paper could help to guide intensivists and haematologists during the difficult decision-making process regarding ECMO candidacy in adult patients receiving HCT. The statements could also serve as a basis for future research focused on ECMO selection criteria and bedside management.

KW - Humans

KW - Adult

KW - Extracorporeal Membrane Oxygenation/methods

KW - Hematopoietic Stem Cell Transplantation

KW - Heart Failure

KW - Consensus

U2 - 10.1016/S2213-2600(22)00535-5

DO - 10.1016/S2213-2600(22)00535-5

M3 - Guideline, recommendation, statement

C2 - 36924784

VL - 11

SP - 477

EP - 492

JO - LANCET RESP MED

JF - LANCET RESP MED

SN - 2213-2600

IS - 5

ER -