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.
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