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Published on: October 24, 2018
Pediatric Hematology and Oncology Patients on Extracorporeal Membrane Oxygenation: Outcomes in a Multicenter,
Michael Colin Mowrer1, Lisa Lima2, Rohit Nair3
1Division of Critical Care Medicine, Cook Children's Medical Center, Fort Worth, TX.
Insights
Survival rates for pediatric cancer patients on extracorporeal membrane oxygenation (ECMO) are 52-64% to decannulation but remain poor upon hospital discharge. Further research is needed to improve outcomes for these critically ill children.
Area of Science:
- Pediatric critical care medicine
- Hematology-oncology
- Cardiopulmonary support
Background:
- Extracorporeal membrane oxygenation (ECMO) is a vital life support system for critically ill children.
- Pediatric patients with oncologic diagnoses or hematopoietic cell transplants (HCT) represent a vulnerable population requiring advanced support.
- Understanding survival predictors in this cohort is crucial for optimizing treatment strategies.
Purpose of the Study:
- To identify characteristics associated with survival in pediatric patients with cancer or HCT receiving ECMO.
- To evaluate survival outcomes to ECMO decannulation and hospital discharge in this specific patient group.
Main Methods:
- A multicenter, retrospective study was conducted across 16 pediatric intensive care units (PICUs) in the US and Israel.
- The study included 149 pediatric patients (age <19 years) with oncologic diagnoses or HCT requiring ECMO between 2009 and 2021.
- Data on patient characteristics, ECMO indications, and outcomes were analyzed.
Main Results:
- Overall survival to ECMO decannulation was 52% for the oncologic group and 64% for the HCT group.
- Survival to hospital discharge was significantly lower, at 36% for the oncologic group and 42% for the HCT group.
- Cardiopulmonary resuscitation prior to ECMO was associated with increased mortality (OR 3.0, 95% CI 1.2-7.7).
Conclusions:
- Pediatric oncologic and HCT patients supported with ECMO demonstrate moderate survival to decannulation but poor survival to hospital discharge.
- A significant survival gap exists between ECMO decannulation and hospital discharge in these patients.
- Further research is warranted to elucidate factors contributing to this survival disparity and improve long-term outcomes.
Objective:
To describe characteristics associated with survival for pediatric patients with an oncologic diagnosis or hematopoietic cell transplant (HCT) supported with extracorporeal membrane oxygenation (ECMO).
Design:
Multicenter, retrospective study.
Setting:
Sixteen PICUs in the United States and Israel.
Patients:
We included patients aged younger than 19 years with an oncologic diagnosis or HCT who required ECMO support between 2009 and 2021.
Interventions:
None.
Measurements And Main Results:
A total of 149 patients were included in the study cohort. There were 118 patients with an oncologic diagnosis and 31 that received HCT. The indications for ECMO were respiratory failure (46%), combined respiratory and cardiac failure (28%), and cardiac failure (25%). Venovenous (V-V) ECMO was used in 45% of patients, with 53% of patients being placed on venoarterial (V-A) ECMO. For oncologic and HCT groups, survival to ECMO decannulation was 52% (62/118) and 64% (20/31), and survival to hospital discharge was 36% (43/118) and 42% (13/31), respectively. After adjusting for other factors, requiring cardiopulmonary resuscitation was associated with greater odds ratio of mortality (3.0 [95% CI, 1.2-7.7]).
Conclusions:
Survival to ECMO decannulation of pediatric oncologic and HCT patients in this study was 52-64%, depending upon diagnosis. However, survival to hospital discharge remains poor. Future research should prioritize understanding factors contributing to this survival gap within these patient populations.
