Extracorporeal membrane oxygenation in oncological patients: singe-center experience.

Hintergrund Patients undergoing oncologic surgery may require extracorporeal membrane oxygenation (ECMO) support because of severe acute respiratory distress syndrome (ARDS), mediastinal compression or postoperative respiratory failure following tumor resection. ECMO use for temporary respiratory and circulatory support remains controversial in this patient cohort due complications, such as bleeding, infection, treatment-related reactions, and potential disease progression.

Material und Methode Data from 71 patients who received ECMO support at a maximum care center between 2014 and 2023 were analyzed. The study cohort was divided into cancer patients (CP; n=33) and ARDS-patients (ARDS; n=38). Demographic, pre-, intra-, and post-ECMO data including laboratory were collected and treatment effect, complications and patient survival were evaluated.

Ergebnis CPs consisted of the following tumors: lung cancer (n=11, 33%), mediastinal tumor (n=2, 6%), other solid tumors (n=12, 37%), blood cancer (n=7, 21%), and sarcoma (n=1, 3%). CPs required more often veno-arterial ECMO support compared to ARDS-patients (21% vs. 3%, p=0.014). Surgical treatment in the form of organ resection was performed in 77% of patients: most patients underwent lung resection (37%) or gastrointestinal resection (37%), resection of mediastinal tumor (6%), and other (6%). Complication rates in the course of surgical treatment or ECMO support were comparable in both groups. There was a significant difference between the two groups regarding hospital survival (60 days): 9 CP (27%) and 28 ARDS-patients (74%) were discharged from the hospital (p<0.001). No patients with a hematological malignancy, and 9 patients with solid tumors (3 patients with lung cancer, 2 patients with intestinal cancer, one patient each with testicular, liver and mediastinal tumor, as well as one patient each with muscular sarcoma) survived ECMO support. The presence of a tumor (OR: 0.134; 95% CI: 0.047-0.384, p<0. 001) and an acute liver failure (OR: 0.077; 95% CI: 0.009-0.648, p=0.018) were the most crucial factors of mortality.

Schlussfolgerung The use of ECMO in CP is associated with a high mortality rate, and requires exploring further treatment approaches. Despite the high mortality rate, patients with lung cancer and other solid tumors had a better chance of being rescued in this severe combination of oncological disease and ECMO support.

 

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Publication History

Article published online:
13 August 2024