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Critical Care
Published in: Critical Care 1/2014

Open Access 01-02-2014 | Research

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

Authors: Philipp Wohlfarth, Roman Ullrich, Thomas Staudinger, Andja Bojic, Oliver Robak, Alexander Hermann, Barbara Lubsczyk, Nina Worel, Valentin Fuhrmann, Maria Schoder, Martin Funovics, Werner Rabitsch, Paul Knoebl, Klaus Laczika, Gottfried J Locker, Wolfgang R Sperr, Peter Schellongowski, Arbeitsgruppe für hämato-onkologische Intensivmedizin der Österreichischen Gesellschaft für Internistische und Allgemeine Intensivmedizin und Notfallmedizin (ÖGIAIN)

Published in: Critical Care | Issue 1/2014

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Abstract

Introduction

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

Methods

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

Results

Before ECMO, the PaO2/FiO2 ratio was 60 (53 to 65), (3.3 to 3.7). Three patients received venoarterial ECMO because of acute circulatory failure in addition to ARF; all other patients received venovenous 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 HMs and ARF and can be associated with long-term disease-free survival.
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Metadata
Title
Extracorporeal membrane oxygenation in adult patients with hematologic malignancies and severe acute respiratory failure
Authors
Philipp Wohlfarth
Roman Ullrich
Thomas Staudinger
Andja Bojic
Oliver Robak
Alexander Hermann
Barbara Lubsczyk
Nina Worel
Valentin Fuhrmann
Maria Schoder
Martin Funovics
Werner Rabitsch
Paul Knoebl
Klaus Laczika
Gottfried J Locker
Wolfgang R Sperr
Peter Schellongowski
Arbeitsgruppe für hämato-onkologische Intensivmedizin der Österreichischen Gesellschaft für Internistische und Allgemeine Intensivmedizin und Notfallmedizin (ÖGIAIN)
Publication date
01-02-2014
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2014
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc13701

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