Key result
In patients requiring ECMO, active hematologic malignancy was associated with significantly lower survival to hospital discharge than nonhematologic malignancy (13.3% vs. 38.2%, P=0.026).
Why the study?
Although cancer ICU admissions are increasing, data regarding the use of extracorporeal membrane oxygenation in patients with malignancy remain limited.
Does active hematologic malignancy compared to nonhematologic malignancy reduce survival to hospital discharge in patients requiring extracorporeal membrane oxygenation?
Cohort (n=98)
No
Does active hematologic malignancy compared to nonhematologic malignancy reduce survival to hospital discharge in patients requiring extracorporeal membrane oxygenation?
Absolute Event Rate: 13.3% vs 38.2%
p-value: p=0.026
ECMO in patients with active hematologic malignancy is associated with significantly lower hospital and 6-month survival compared to those with nonhematologic malignancy, suggesting it should be reserved for highly selected cases.
ECMO in carefully selected active malignancy patients remains hypothesis-generating; prospective trials needed before broader adoption.
Although the number of cancer patients admitted to the intensive care unit is increasing, the data on the use of extracorporeal membrane oxygenation in patients with malignancy are limited. We applied extracorporeal membrane oxygenation to carefully selected patients with active hematologic malignancy or nonhematologic malignancy who experienced respiratory or cardiac failure despite maximal conventional therapy. Patients with active malignancy who underwent extracorporeal membrane oxygenation in our institution between January 2012 and December 2016 were included in this study. The primary outcome of this study was defined as survival to hospital discharge. We also investigated the factors associated with survival to hospital discharge. There were 30 (30.6%) and 68 (69.4%) patients in the hematologic malignancy group and the nonhematologic malignancy group, respectively. Patients in the hematologic malignancy group were younger, more neutropenic, more hypotensive, had a lower Charlson Comorbidity Index, higher sequential organ failure assessment score, and lower platelet count than those in the nonhematologic malignancy group. Forty-six (46.9%) patients were successfully weaned off extracorporeal membrane oxygenation, and 30 (30.6%) patients survived until hospital discharge. Hospital survival rate and survival status 6 months after hospital discharge were significantly lower in patients with hematologic malignancy than in those with nonhematologic malignancy (13.3% vs. 38.2%, P = .026 and 3.3% vs. 26.5%, P = .017, respectively). Multivariate analysis identified an active hematologic malignancy, older age, acidosis, thrombocytopenia, high vasoactive-inotrope score, and respiratory failure as the risk factors for in-hospital death. Patients with hematologic malignancy requiring extracorporeal membrane oxygenation support had significantly lower rates of hospital survival and 6-month survival after discharge than patients with nonhematologic malignancy. Therefore, extracorporeal membrane oxygenation for treating cardiac or respiratory failure should only be considered in highly selected patients with hematologic malignancy.
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Park et al. (2021) conducted a cohort in Active hematologic and nonhematologic malignancy with respiratory or cardiac failure (n=98). Active hematologic malignancy vs. Active nonhematologic malignancy was evaluated on Survival to hospital discharge (p=0.026). In patients requiring ECMO, active hematologic malignancy was associated with significantly lower survival to hospital discharge than nonhematologic malignancy (13.3% vs. 38.2%, P=0.026).
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