Pediatric Hematology and Oncology Patients on Extracorporeal Membrane Oxygenation: Outcomes in a Multicenter, Retrospective Cohort 2009-2021

Michael Colin Mowrer, Division of Critical Care Medicine, Cook Children's Medical Center, Fort Worth, TX.
Lisa Lima, Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA.
Rohit Nair, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA.
Xilong Li, Peter O'Donnell Jr School of Public Health, UT Southwestern Medical Center, Dallas, TX.
Hitesh Sandhu, Department of Pediatrics, Division of Critical Care Medicine, University of Tennessee Health Science Center, Memphis, TN.
Brian Bridges, Division of Pediatric Critical Care Medicine, Vanderbilt University, Nashville, TN.
Ryan P. Barbaro, Division of Critical Care Medicine and Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, MI.
Saleh Bhar, Divisions of Critical Care Medicine and Hematology Oncology, Pediatric Cell Therapy and Bone Marrow Transplant, Baylor College of Medicine, Texas Children's Hospital, Houston, TX.
Raymond Nkwantabisa, Division of Critical Care Medicine, Cook Children's Medical Center, Fort Worth, TX.
Saad Ghafoor, Division of Critical Care Medicine, St. Jude Children's Research Hospital, Memphis, TN.
Agnes Reschke, Department of Pediatric Critical Care Medicine, Stanford University, Palo Alto, CA.
Taylor Olson, Department of Pediatrics, Division of Critical Care Medicine, Children's National Hospital and George Washington University School of Medicine and Health Sciences, Washington, DC.
Matthew P. Malone, Department of Pediatrics, Division of Critical Care Medicine, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR.
Neel Shah, Department of Pediatrics, Washington University St. Louis, St. Louis, MO.
Matt S. Zinter, Divisions of Critical Care and Bone Marrow Transplantation, Department of Pediatrics, University of California San Francisco, San Francisco, CA.
Jon Gehlbach, Division of Pediatric Critical Care Medicine, University of Illinois College of Medicine Peoria, Peoria, IL.
Laura Hollinger, Division of Pediatric Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC.
Briana L. Scott, Division of Critical Care Medicine, University of Rochester Medical Center, Rochester, NY.
Reut Kassif Lerner, Department of Pediatric Intensive Care, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Israel.
Thomas V. Brogan, Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA.
Lakshmi Raman, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX.
Renee M. Potera, Division of Critical Care Medicine, Phoenix Children's Hospital, Phoenix, AZ.

Document Type

Journal Article

Publication Date

7-19-2024

Journal

Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

DOI

10.1097/PCC.0000000000003584

Abstract

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.

Department

Pediatrics

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