Extracorporeal membrane oxygenation in adult patients with hematologic malignancies and severe acute respiratory failure

被引:77
作者
Wohlfarth, Philipp [1 ]
Ullrich, Roman [2 ]
Staudinger, Thomas [1 ]
Bojic, Andja [1 ]
Robak, Oliver [1 ]
Hermann, Alexander [1 ]
Lubsczyk, Barbara [2 ]
Worel, Nina [3 ]
Fuhrmann, Valentin [4 ]
Schoder, Maria [5 ]
Funovics, Martin [5 ]
Rabitsch, Werner [1 ]
Knoebl, Paul [1 ]
Laczika, Klaus [1 ]
Locker, Gottfried J. [1 ]
Sperr, Wolfgang R. [1 ]
Schellongowski, Peter [1 ]
机构
[1] Med Univ Vienna, Dept Med 1, Intens Care Unit 13I2, Ctr Comprehens Canc, A-1090 Vienna, Austria
[2] Med Univ Vienna, Dept Anaesthesia, Intens Care Unit 13C2, A-1090 Vienna, Austria
[3] Med Univ Vienna, Dept Bloodgrp Serol & Transfus Med, A-1090 Vienna, Austria
[4] Med Univ Vienna, Dept Med 3, Intens Care Unit 13H1, A-1090 Vienna, Austria
[5] Med Univ Vienna, Dept Biomed Imaging & Image Guided Therapy, Div Cardiovasc & Intervent Radiol, A-1090 Vienna, Austria
来源
CRITICAL CARE | 2014年 / 18卷 / 01期
关键词
INTENSIVE-CARE-UNIT; STEM-CELL TRANSPLANTATION; CANCER-PATIENTS; DISTRESS-SYNDROME; VENTILATORY SUPPORT; LIFE-SUPPORT; EXPERIENCE; MULTICENTER; DEFINITION; ADMISSION;
D O I
10.1186/cc13701
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Introduction: Acute respiratory failure (ARF) is the main reason for intensive care unit (ICU) admissions in patients with hematologic malignancies (HMs). We report the first series of adult patients with ARF and HMs treated with extracorporeal membrane oxygenation (ECMO). Methods: This is a retrospective cohort study of 14 patients with HMs (aggressive non-Hodgkin lymphoma (NHL) n = 5; highly aggressive NHL, that is acute lymphoblastic leukemia or Burkitt lymphoma, n = 5; Hodgkin lymphoma, n = 2; acute myeloid leukemia, n = 1; multiple myeloma, n = 1) receiving ECMO support because of ARF (all data as medians and interquartile ranges; age, 32 years (22 to 51 years); simplified acute physiology score II (SAPS II): 51 (42 to 65)). Etiology of ARF was pneumonia (n = 10), thoracic manifestation of NHL (n = 2), sepsis of nonpulmonary origin (n = 1), and transfusion-related acute lung injury (n = 1). Diagnosis of HM was established during ECMO in four patients, and five first received (immuno-) chemotherapy on ECMO. Results: Before ECMO, the PaO2/FiO(2) ratio was 60 (53 to 65), (3.3 to 3.7). Three patients received venoarterial ECMO because of acute circulatory failure in addition to ARF; all other patients received venovenous ECMO. All patients needed vasopressors, and five needed hemofiltration. Thrombocytopenia occurred in all patients (lowest platelet count was 20 (11 to 21) G/L). Five major bleeding events were noted. ECMO duration was 8.5 (4 to 16) days. ICU and hospital survival was 50%. All survivors were alive at follow-up (36 (10 to 58) months); five patients were in complete remission, one in partial remission, and one had relapsed. Conclusions: ECMO therapy is feasible in selected patients with HMs and ARF and can be associated with long-term disease-free survival.
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页数:8
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