Cho, Sungbin
(Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine)
,
Cho, Won Chul
(Department of Thoracic and Cardiovascular Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine)
,
Lim, Ju Yong
(Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Korea University College of Medicine)
,
Kang, Pil Je
(Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine)
Background: The primary goal of this study was to characterize the clinical outcomes of adult patients with hematologic malignancies (HM) who were treated with extracorporeal membrane oxygenation (ECMO) support when conventional treatments failed. Methods: In this retrospective, observational study ...
Background: The primary goal of this study was to characterize the clinical outcomes of adult patients with hematologic malignancies (HM) who were treated with extracorporeal membrane oxygenation (ECMO) support when conventional treatments failed. Methods: In this retrospective, observational study at a tertiary medical center, we reviewed the clinical course of 23 consecutive patients with HM requiring ECMO who were admitted to the intensive care unit at Asan Medical Center from March 2010 to April 2015. Results: A total of 23 patients (8 female; median age, 44 years; range, 29-51 years) with HM and severe acute circulatory and/or respiratory failure received ECMO therapy during the study period. Fourteen patients received veno-arterial ECMO, while 9 patients received veno-venous ECMO. The median ECMO duration was 104.7 hours (range, 37.1-221 hours). Nine patients were successfully weaned from ECMO. The in-hospital mortality rate was 91.1% (21 of 23). There were complications in 3 patients (cannulation site bleeding, limb ischemia, and gastrointestinal bleeding). Conclusion: ECMO is a useful treatment for patients with circulatory and/or pulmonary failure. However, in patients with HM, the outcomes of ECMO treatment results were very poor, so it is advisable to carefully decide whether to apply ECMO to these patients.
Background: The primary goal of this study was to characterize the clinical outcomes of adult patients with hematologic malignancies (HM) who were treated with extracorporeal membrane oxygenation (ECMO) support when conventional treatments failed. Methods: In this retrospective, observational study at a tertiary medical center, we reviewed the clinical course of 23 consecutive patients with HM requiring ECMO who were admitted to the intensive care unit at Asan Medical Center from March 2010 to April 2015. Results: A total of 23 patients (8 female; median age, 44 years; range, 29-51 years) with HM and severe acute circulatory and/or respiratory failure received ECMO therapy during the study period. Fourteen patients received veno-arterial ECMO, while 9 patients received veno-venous ECMO. The median ECMO duration was 104.7 hours (range, 37.1-221 hours). Nine patients were successfully weaned from ECMO. The in-hospital mortality rate was 91.1% (21 of 23). There were complications in 3 patients (cannulation site bleeding, limb ischemia, and gastrointestinal bleeding). Conclusion: ECMO is a useful treatment for patients with circulatory and/or pulmonary failure. However, in patients with HM, the outcomes of ECMO treatment results were very poor, so it is advisable to carefully decide whether to apply ECMO to these patients.
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제안 방법
The primary goal of this study was to characterize the clinical outcomes of adult patients with HM who were treated with ECMO when conventional treatments failed, based on a retrospective review of the patients’ medical records.
The baseline characteristics of patients were evaluated. Additionally, disease severity scores were calculated using the Acute Physiology and Chronic Health Evaluation (APACHE) II, Murray Lung Injury Score, the Respiratory Extracorporeal Membrane Oxygenation Survival Prediction Score, and the Simplified Acute Physiology Score (SAPS) II. The type of HM, the reason for ECMO, the type of ECMO, clinical considerations before and during ECMO, complications during ECMO, and the success or failure of ECMO weaning were analyzed based on the data available in the patients’ medical records.
The type of HM, the reason for ECMO, the type of ECMO, clinical considerations before and during ECMO, complications during ECMO, and the success or failure of ECMO weaning were analyzed based on the data available in the patients’ medical records. Laboratory data, including hemoglobin, white blood cell count, platelet count, C-reactive protein, blood urea nitrogen (BUN), creatinine, albumin, and liver function tests were collected during the ICU stay. The period of ICU admission, length of hospital stay, and time in hospital before ICU admission were noted.
ICU mortality was 70% (16 of 23), and the in-hospital mortality rate was 91% (21 of 23). Multivariate analysis was performed of HM patients with the following risk factors for unsuccessful weaning from ECMO: age, APACHE II score, SAPS II score, BUN level, hemoglobin level, platelet level at ECMO initiation, lactate level on the first day of ECMO, and the time from ICU admission to ECMO initiation. In the univariate analysis, the age and BUN level at ECMO initiation in the patients who were weaned from ECMO were significantly lower than in the patients who were not (p＜0.
대상 데이터
All study participants had thrombocytopenia (＜100×103/μL), except for 3 individuals.
Leukopenia (＜4×103/μL) was present in 15 patients.
Fifteen of the patients were men, and the median age was 44 years (range, 29–51 years).
데이터처리
2. Age (A) and BUN levels at ECMO initiation (B) in patients weaned from ECMO were significantly lower than in those who were not weaned from ECMO in the univariate analysis (age: p=0.03; BUN: p=0.03) in a logistic regression model. ECMO, extracorporeal membrane oxygenation.
이론/모형
Data were compared using the Mann– Whitney U-test for continuous variables and the chi-square or Fisher exact test for categorical variables.
성능/효과
a)The criteria for an immune-compromised state were as follows: human immunodeficiency virus, aprimary immune deficiency, hematologic malignancy such as lymphoma, post-chemotherapy status, an absolute neutrophil count ＜1,000, steroid medication (＞0.5 mg/kg) for more than 3 weeks, or post-transplantation status.
Second, the number of patients in this study was small. Third, the ECMO application criteria were not clearly defined in objective terms, and showed significant variation according to various factors, including the preference of the doctor in charge.
In conclusion, patients with HM who require ECMO for acute circulatory and/or respiratory support have poor outcomes. When ECMO was applied to patients with HM, the ECMO weaning rate was 39% (9 of 23) and the in-hospital mortality rate during the same hospitalization period was 91% (21 of 23).
후속연구
In reality, there will be a demand for ECMO application in patients with HM who do not respond to conventional therapy. More research is needed to improve ECMO results in these patients.
1 Le Gall A Follin A Cholley B Mantz J Aissaoui N Pirracchio R Veno-arterial-ECMO in the intensive care unit: from technical aspects to clinical practice Anaesth Crit Care Pain Med 2018 37 259 68 10.1016/j.accpm.2017.08.007 29033360
2 Wu MY Huang CC Wu TI Wang CL Lin PJ Venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome in adults: prognostic factors for outcomes Medicine (Baltimore) 2016 95 e2870 10.1097/MD.0000000000002870 26937920
4 Azoulay E Pene F Darmon M Managing critically Ill hematology patients: time to think differently Blood Rev 2015 29 359 67 10.1016/j.blre.2015.04.002 25998991
5 Hampshire PA Welch CA McCrossan LA Francis K Harrison DA Admission factors associated with hospital mortality in patients with haematological malignancy admitted to UK adult, general critical care units: a secondary analysis of the ICNARC Case Mix Programme Database Crit Care 2009 13 R137 10.1186/cc8016 2750195 --> 19706163
6 Aygencel G Turkoglu M Turkoz Sucak G Benekli M Prognostic factors in critically ill cancer patients admitted to the intensive care unit J Crit Care 2014 29 618 26 10.1016/j.jcrc.2014.01.014 24612762
7 Massion PB Dive AM Doyen C Prognosis of hematologic malignancies does not predict intensive care unit mortality Crit Care Med 2002 30 2260 70 10.1097/00003246-200210000-00014 12394954
8 Seong GM Lee Y Hong SB Lim CM Koh Y Huh JW Prognosis of acute respiratory distress syndrome in patients with hematological malignancies J Intensive Care Med 2018 885066617753566 10.1177/0885066617753566 29343171
9 Choi KB Kim HW Jo KH Kim DY Choi HJ Hong SB Extracorporeal life support in patients with hematologic malignancies: a single center experience Korean J Thorac Cardiovasc Surg 2016 49 280 6 10.5090/kjtcs.2016.49.4.280 4981230 --> 27525237
10 Kang HS Rhee CK Lee HY Clinical outcomes of extracorporeal membrane oxygenation support in patients with hematologic malignancies Korean J Intern Med 2015 30 478 88 10.3904/kjim.2015.30.4.478 4497335 --> 26161014
11 Wohlfarth P Ullrich R Staudinger T Extracorporeal membrane oxygenation in adult patients with hematologic malignancies and severe acute respiratory failure Crit Care 2014 18 R20 10.1186/cc13701 4055976 --> 24443905
12 Wohlfarth P Beutel G Lebiedz P Characteristics and outcome of patients after allogeneic hematopoietic stem cell transplantation treated with extracorporeal membrane oxygenation for acute respiratory distress syndrome Crit Care Med 2017 45 e500 7 10.1097/CCM.0000000000002293 28410318
13 Patel JD Krilov L Adams S Clinical cancer advances 2013: annual report on progress against cancer from the American Society of Clinical Oncology J Clin Oncol 2014 32 129 60 10.1200/JCO.2013.53.7076 24327669
14 Sant M Minicozzi P Mounier M Survival for haematological malignancies in Europe between 1997 and 2008 by region and age: results of EUROCARE-5, a population-based study Lancet Oncol 2014 15 931 42 10.1016/S1470-2045(14)70282-7 25030467
15 Bird GT Farquhar-Smith P Wigmore T Potter M Gruber PC Outcomes and prognostic factors in patients with haematological malignancy admitted to a specialist cancer intensive care unit: a 5 yr study Br J Anaesth 2012 108 452 9 10.1093/bja/aer449 22298243
16 Rhee CK Kang JY Kim YH Risk factors for acute respiratory distress syndrome during neutropenia recovery in patients with hematologic malignancies Crit Care 2009 13 R173 10.1186/cc8149 2811915 --> 19886984
18 Corcia Palomo Y Knight Asorey T Espigado I Martin Villen L Garnacho Montero J Mortality of oncohematological patients undergoing hematopoietic stem cell transplantation admitted to the intensive care unit Transplant Proc 2015 47 2665 6 10.1016/j.transproceed.2015.09.033 26680067
19 Schmidt M Brechot N Combes A Ten situations in which ECMO is unlikely to be successful Intensive Care Med 2016 42 750 2 10.1007/s00134-015-4013-9 26271905
20 Park TS Oh YN Hong SB Extracorporeal membrane oxygenation support in adult patients with hematologic malignancies and severe acute respiratory failure Korean J Crit Care Med 2016 31 243 50 10.4266/kjccm.2016.00318
21 Pulte D Jansen L Castro FA Brenner H Changes in the survival of older patients with hematologic malignancies in the early 21st century Cancer 2016 122 2031 40 10.1002/cncr.30003 27163715
22 Parakh S Piggin A Neeman T Mitchell I Crispin P Davis A Outcomes of haematology/oncology patients admitted to intensive care unit at the Canberra Hospital Intern Med J 2014 44 1087 94 10.1111/imj.12545 25132619
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