Korean J Intern Med.  2015 Jul;30(4):478-488. 10.3904/kjim.2015.30.4.478.

Clinical outcomes of extracorporeal membrane oxygenation support in patients with hematologic malignancies

• Kang HS
• Rhee CK
• Lee HY
• Kim YK
• Kwon SS
• Kim SC
• Lee JW

• KMID: 2366008
• DOI: http://doi.org/10.3904/kjim.2015.30.4.478

Abstract

BACKGROUND/AIMS
The clinical outcomes of patients with hematologic malignancies who were treated with extracorporeal membrane oxygenation (ECMO) after the failu re of optimal conventional therapy were determined.
METHODS
The medical records of all patients administered ECMO during their stay in a medical intensive care unit of Seoul St. Mary's Hospital between February 2010 and July 2013 were reviewed retrospectively.
RESULTS
In total, 15 patients with hematologic malignancies were compared to 33 immunocompetent patients with documented cardiorespiratory failure. Underlying hematologic malignancies were significantly associated with lower overall survival (0.0% vs. 24.2%, p = 0.044). Mortality was significantly associated with a higher 24 hours ECMO inspired fraction of oxygen (0.71 +/- 0.24 vs. 0.47 +/- 0.13, p = 0.015), the development of infection after ECMO (87.5% vs. 25.0%, p = 0.001), and the presence of hyperbilirubinemia (70.0% vs. 0.0%, p < 0.001). Matching of the patients based on their Acute Physiology and Chronic Health Evaluation II scores confirmed the greater risk of mortality in patients with hematologic malignancies (survival: 0.0% vs. 40.0%, p = 0.017). The mean difference in inotropic-equivalent scores after ECMO was significantly lower in the immunocompetent patients than in those with hematologic malignancies (-59.22 +/- 97.83 vs. 53.87 +/- 164.46, p = 0.026).
CONCLUSIONS
Patients with hematologic malignancies who require ECMO for respiratory support have poor outcomes. The incidence of complications in these patients did not significantly differ from that in immunocompetent patients.

Keyword

Extracorporeal membrane oxygenation; Hematologic neoplasms; Adults; Mortality; Complications

MeSH Terms

APACHE
Adult
Aged
*Extracorporeal Membrane Oxygenation/adverse effects/mortality
Female
Hematologic Neoplasms/diagnosis/mortality/*therapy
Hospital Mortality
Humans
Kaplan-Meier Estimate
Male
Medical Records
Middle Aged
Predictive Value of Tests
Republic of Korea
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome