Extracorporeal membrane oxygenation in acute respiratory failure in oncohematological patients

Introduction. Pulmonary complications and acute respiratory failure (ARF) are among the most severe complications of hematologic malignancies and their treatment. When conventional respiratory support fails, extracorporeal membrane oxygenation (ECMO) may serve as a rescue therapy. However, its use in patients with hematologic malignancies remains controversial. The objective was to present a case series of veno-venous ECMO support for ARF in patients with hematologic malignancies and to evaluate the outcomes. Materials and methods. A retrospective study was conducted at the National Medical Research Center for Hematology and included adult patients with diseases of the hematopoietic system who required ECMO support for severe acute respiratory failure between 2018 and 2025. The clinical characteristics of patients, the stage and type of tumor disease, prior treatment, indices of organ dysfunction (APACHE II, SOFA), parameters of gas-exchange and hemostasis were evaluated. The etiology of pulmonary involvement was investigated, and central hemodynamic parameters, coagulation profiles and laboratory findings were monitored. Duration of ECMO support, the need for renal replacement therapy, treatment-related complications, and clinical outcomes were recorded. Descriptive statistical methods were applied; results are presented as medians with interquartile ranges. Overall survival was estimated using the Kaplan – Meier method. Results. The study cohort comprised 8 adult patients with different hematologic malignancies. Prior to ECMO initiation, all patients exhibited severe hypoxemia unresponsive to conventional respiratory support. Infectious lung injury of mixed etiology was identified in most cases, whereas neoplastic pulmonary infiltration was diagnosed in one patient. Thrombocytopenia (< 50×10⁹/L) was present in 63% of patients. The median duration of ECMO therapy was 13 days. Successful discontinuation of ECMO support was achieved in two patients. Major complications were predominantly hemorrhagic, including intracranial bleeding, and were frequently associated with significant coagulation disturbances complicating anticoagulation management. Conclusion. VV-ECMO may serve as a rescue therapy for selected patients with hematologic malignancies who develop refractory acute respiratory failure. However, its use is associated with a substantial risk of severe complications and poor outcomes. Careful patient selection is therefore essential and should consider the prognosis of the underlying disease, the likelihood of bone marrow recovery, and the potential effectiveness of antitumor therapy. Early identification of the cause of pulmonary injury and timely initiation of appropriate targeted treatment are critical factors influencing the success of ECMO support.