Extracorporeal membrane oxygenation in adult patients with hematologic malignancies and severe acute respiratory failure

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

METHODS: This is a retrospective cohort study on 14 patients with HM (aggressive non-Hodgkin lymphoma (NHL) n = 5; highly aggressive NHL, that is acute lymphoblastic leukemia or Burkitt's lymphoma, n = 5; Hodgkin's lymphoma, n = 2; acute myeloid leukemia, n = 1; multiple myeloma, n = 1) receiving ECMO support due to ARF (all data as medians and interquartile ranges; age: 32 years (22 to 51); 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 non-pulmonary origin (n = 1), and transfusion related acute lung injury (n = 1). Diagnosis of HM was established during ECMO in four patients, and five firstly received (immuno-) chemotherapy on ECMO.

RESULTS: Prior to ECMO, the PaO2/FiO2-ratio was 60 (53 to 65) and the lung injury score 3.3 (3.3 to 3.7). Three patients received veno-arterial ECMO due acute circulatory failure in addition to ARF, all other patients received veno-venous 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 HM and ARF and can be associated with long-term disease-free survival.