Advanced circulatory support in oncologic patients with refractory cardiorespiratory failure

Advances in oncology and critical care have reshaped the profile of intensive care unit (ICU) patients, increasing encounters with cancer patients who develop refractory cardiorespiratory failure. The use of Extracorporeal Circulatory Support (ECLS), including extracorporeal membrane oxygenation (ECMO), has expanded beyond traditional indications, raising complex clinical, physiological, and ethical questions in oncologic populations. This chapter describes the current role of ECLS in critically ill patients with solid and hematologic malignancies, integrating available evidence on indications, patient selection, physiological considerations, complications, and reported outcomes. The discussion emphasizes the heterogeneity of study findings and the consistently limited observed outcomes. The chapter frames ECLS as a highly selective intervention, best guided by emerging cohort-level data, multidisciplinary evaluation, and careful alignment with oncologic trajectory, reversibility of organ failure, and patient-centered goals of care.