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Extracorporeal membrane oxygenation in patients with hematologic malignancies: a systematic review and meta-analysis

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Abstract

Hematological malignancies (HM) have been, until recently, viewed as contraindications to extracorporeal membrane oxygenation (ECMO) due to bleeding and infectious complications. However, conflicting literature regarding whether ECMO should be used for patients with HM still exists. We conducted a random effects meta-analysis to investigate the outcomes of patients with HM on ECMO. We searched Medline, Embase, Scopus, and Cochrane through 10 October 2021. Risk of bias and certainty of evidence were assessed using the JBI checklists and GRADE approach respectively. Thirteen observational studies (422 patients with HM, 9778 controls without HM) were included. The pooled in-hospital mortality for patients with HM and those with hematopoietic stem cell transplants for HM indications needing ECMO were 79.1% (95%CI: 70.2–86.9%) and 87.7% (95%CI: 80.4–93.8%), respectively. Subgroup analyses found that mortality was higher in adults than children (85.1% vs 67.9%, pinteraction = 0.003), and in Asia compared to North America and Europe (93.8% vs 69.6%, pinteraction < 0.001). Pooled ECMO duration was 10.0 days (95%CI: 7.5–12.5); pooled ICU and hospital lengths of stay were 19.8 days (95%CI: 12.4–27.3) and 43.9 days (95%CI: 29.4–58.4) respectively. Age (regression coefficient [B]: 0.008, 95%CI: 0.003–0.014), proportion of males (B: 1.799, 95%CI: 0.079–3.519), and ECMO duration (B: − 0.022, 95%CI: − 0.043 to − 0.001) were significantly associated with higher mortality. In-hospital mortality of patients with HM who needed ECMO was 79.1%, with better outcomes in children, and in North America and Europe. ECMO should not be regarded as routine support therapy in these patients but can be carefully considered on a case-by-case basis.

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References

  1. Manaker S, Parsons PE, Finlay G (2021) Extracorporeal membrane oxygenation (ECMO) in adults. UpToDate https://www.uptodate.com/contents/extracorporeal-membrane-oxygenation-ecmo-in-adults. Accessed November 17, 2021

  2. Cashen K, Reeder R, Dalton HJ et al (2017) Functional status of neonatal and pediatric patients after extracorporeal membrane oxygenation. Pediatr critical care med : J Soc Critical Care Med World Federation Pediatr Intensive Critical Care Soc 18(6):561–570

    Article  Google Scholar 

  3. Kosmopoulos M, Bartos JA, Kalra R et al (2021) Patients treated with venoarterial extracorporeal membrane oxygenation have different baseline risk and outcomes dependent on indication and route of cannulation. Hellenic J Cardiol 62(1):38–45

    Article  Google Scholar 

  4. Park TS, Oh YN, Hong S-B et al (2016) Extracorporeal membrane oxygenation support in adult patients with hematologic malignancies and severe acute respiratory failure. Korean J Crit Care Med 31(3):243–250

    Article  Google Scholar 

  5. Azoulay E, Mokart D, Pene F et al (2013) Outcomes of critically ill patients with hematologic malignancies: prospective multicenter data from France and Belgium–a groupe de recherche respiratoire en reanimation onco-hematologique study. J Clin Oncol 31(22):2810–2818

    Article  Google Scholar 

  6. Benoit DD, Vandewoude KH, Decruyenaere JM, Hoste EA, Colardyn FA (2003) Outcome and early prognostic indicators in patients with a hematologic malignancy admitted to the intensive care unit for a life-threatening complication. Crit Care Med 31(1):104–112

    Article  Google Scholar 

  7. Tathineni P, Pandya M, Chaar B (2020) The utility of extracorporeal membrane oxygenation in patients with hematologic malignancies: a literature review. Cureus 12(7):e9118

    PubMed  PubMed Central  Google Scholar 

  8. Taccone FS, Artigas AA, Sprung CL, Moreno R, Sakr Y, Vincent JL (2009) Characteristics and outcomes of cancer patients in European ICUs. Crit Care 13(1):R15

    Article  Google Scholar 

  9. Di Nardo M, Ahmad AH, Merli P, et al. (2021) Extracorporeal membrane oxygenation in children receiving hematopoietic cell transplantation and immune effector cell therapy: an international and multidisciplinary consensus statement. Lancet Child Adolesc Health.

  10. Kang HS, Rhee CK, Lee HY et al (2015) Clinical outcomes of extracorporeal membrane oxygenation support in patients with hematologic malignancies. Korean J Intern Med 30(4):478–488

    Article  CAS  Google Scholar 

  11. Wohlfarth P, Ullrich R, Staudinger T et al (2014) Extracorporeal membrane oxygenation in adult patients with hematologic malignancies and severe acute respiratory failure. Crit Care 18(1):R20

    Article  Google Scholar 

  12. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8(5):336–341

    Article  Google Scholar 

  13. Wan X, Wang W, Liu J, Tong T (2014) Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 14:135

    Article  Google Scholar 

  14. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7(3):177–188

    Article  CAS  Google Scholar 

  15. Miller JJ (1978) The inverse of the Freeman-Tukey double arcsine transformation. Am Stat 32(4):138–138

    Google Scholar 

  16. Clopper CJ, Pearson ES (1934) The use of confidence or fiducial limits illustrated in the case of the binomial. Biometrika 26(4):404–413

    Article  Google Scholar 

  17. Geissbuhler M, Hincapie CA, Aghlmandi S, Zwahlen M, Juni P, da Costa BR (2021) Most published meta-regression analyses based on aggregate data suffer from methodological pitfalls a meta-epidemiological study. BMC Med Res Methodol 21(1):123

    Article  Google Scholar 

  18. Guyatt GH, Oxman AD, Kunz R et al (2011) GRADE guidelines: 7 Rating the quality of evidence--inconsistency. J Clin Epidemiol. 64(12):1294–1302

    Article  Google Scholar 

  19. Iorio A, Spencer FA, Falavigna M et al (2015) Use of GRADE for assessment of evidence about prognosis: rating confidence in estimates of event rates in broad categories of patients. BMJ : British Medical J 350:h870

    Article  Google Scholar 

  20. Cho S, Cho WC, Lim JY, Kang PJ (2019) Extracorporeal life support in adult patients with hematologic malignancies and acute circulatory and/or respiratory failure. Korean J Thorac Cardiovasc Surg 52(1):25–31

    Article  Google Scholar 

  21. Choi KB, Kim HW, Jo KH, Kim do Y, Choi HJ, Hong SB, (2016) Extracorporeal life support in patients with hematologic malignancies: a single center experience. Korean J Thorac Cardiovasc Surg 49(4):280–286

    Article  Google Scholar 

  22. Coleman RD, Goldman J, Moffett B et al (2020) Extracorporeal membrane oxygenation mortality in high-risk populations: an analysis of the pediatric health information system database. ASAIO J 66(3):327–331

    Article  Google Scholar 

  23. Cortina G, Neu N, Kropshofer G, Meister B, Klingkowski U, Crazzolara R (2018) Extracorporeal membrane oxygenation offers long-term survival in childhood leukemia and acute respiratory failure. Crit Care. 22(1):222

    Article  Google Scholar 

  24. Maue DK, Hobson MJ, Friedman ML, Moser EA, Rowan CM (2019) Outcomes of pediatric oncology and hematopoietic cell transplant patients receiving extracorporeal membrane oxygenation. Perfusion 34(7):598–604

    Article  Google Scholar 

  25. Na SJ, Park SH, Hong SB et al (2020) Clinical outcomes of immunocompromised patients on extracorporeal membrane oxygenation support for severe acute respiratory failure. Eur J Cardiothorac Surg 57(4):788–795

    PubMed  Google Scholar 

  26. Potratz JC, Guddorf S, Ahlmann M et al (2021) Extracorporeal membrane oxygenation in children with cancer or hematopoietic cell transplantation: single-center experience in 20 consecutive patients. Front Oncol 11:664928

    Article  Google Scholar 

  27. Ranta S, Kalzen H, Nilsson A et al (2021) Extracorporeal membrane oxygenation support in children with hematologic malignancies in Sweden. J Pediatr Hematol Oncol 43(2):e272–e275

    Article  Google Scholar 

  28. Schmidt M, Schellongowski P, Patroniti N et al (2018) Six-month outcome of immunocompromised patients with severe acute respiratory distress syndrome rescued by extracorporeal membrane oxygenation. An international multicenter retrospective study. Am J Respir Crit Care Med 197(10):1297–1307

    Article  CAS  Google Scholar 

  29. Stecher SS, Beyer G, Goni E et al (2018) Extracorporeal membrane oxygenation in predominantly leuco- and thrombocytopenic haematologic/oncologic patients with acute respiratory distress syndrome - a single-centre experience. Oncol Res Treat 41(9):539–543

    Article  Google Scholar 

  30. Wohlfarth P, Beutel G, Lebiedz P et al (2017) Characteristics and outcome of patients after allogeneic hematopoietic stem cell transplantation treated with extracorporeal membrane oxygenation for acute respiratory distress syndrome. Crit Care Med 45(5):e500–e507

    Article  Google Scholar 

  31. Cortegiani A, Madotto F, Gregoretti C et al (2018) Immunocompromised patients with acute respiratory distress syndrome: secondary analysis of the LUNG SAFE database. Crit Care 22(1):157

    Article  Google Scholar 

  32. Laffey JG, Bellani G, Pham T et al (2016) Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome: the LUNG SAFE study. Intensive Care Med 42(12):1865–1876

    Article  CAS  Google Scholar 

  33. Azoulay E, Lemiale V, Mokart D et al (2014) Acute respiratory distress syndrome in patients with malignancies. Intensive Care Med 40(8):1106–1114

    Article  Google Scholar 

  34. Olson TL, O’Neil ER, Kurtz KJ, MacLaren G, Anders MM (2021) Improving outcomes for children requiring extracorporeal membrane oxygenation therapy following hematopoietic stem cell transplantation. Crit Care Med 49(4):e381–e393

    Article  CAS  Google Scholar 

  35. Tremblay LN, Hyland RH, Schouten BD, Hanly PJ (1995) Survival of acute myelogenous leukemia patients requiring intubation/ventilatory support. Clin Invest Med 18(1):19–24

    CAS  PubMed  Google Scholar 

  36. Turkoglu M, Erdem GU, Suyani E et al (2013) Acute respiratory distress syndrome in patients with hematological malignancies. Hematology 18(3):123–130

    Article  Google Scholar 

  37. Al-Dorzi HM, Al Orainni H, Al Eid F et al (2017) Characteristics and predictors of mortality of patients with hematologic malignancies requiring invasive mechanical ventilation. Ann Thorac Med 12(4):259–265

    Article  Google Scholar 

  38. Schmidt M, Combes A, Shekar K (2019) ECMO for immunosuppressed patients with acute respiratory distress syndrome: drawing a line in the sand. Intensive Care Med 45(8):1140–1142

    Article  Google Scholar 

  39. Extracorporeal Life Support Organization 2017 ELSO guidelines for cardiopulmonary extracorporeal life support. Version 1.4:www.elso.org.

  40. Schmidt M, Bailey M, Sheldrake J et al (2014) Predicting survival after extracorporeal membrane oxygenation for severe acute respiratory failure The Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) score. Am J Respir Crit Care Med 189(11):1374–1382

    Article  Google Scholar 

  41. Schmidt M, Zogheib E, Roze H et al (2013) The PRESERVE mortality risk score and analysis of long-term outcomes after extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. Intensive Care Med 39(10):1704–1713

    Article  CAS  Google Scholar 

  42. Combes A, Hajage D, Capellier G et al (2018) Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med 378(21):1965–1975

    Article  Google Scholar 

  43. Columb MO, Atkinson MS (2016) Statistical analysis: sample size and power estimations. BJA Education 16(5):159–161

    Article  Google Scholar 

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Acknowledgements

The authors extend their appreciation to Suei Nee Wong from the National University of Singapore for her assistance with the search strategy.

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Author notes

  1. Jackie Jia Lin Sim and Saikat Mitra contributed equally to the manuscript.

Authors and Affiliations

  1. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Jackie Jia Lin Sim, Ryan Ruiyang Ling, Graeme MacLaren & Kollengode Ramanathan

  2. Lyell McEwin Hospital, Adelaide, South Australia, Australia

    Saikat Mitra

  3. Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore

    Chuen Seng Tan

  4. Department of Hematology, Tan Tock Seng Hospital, Singapore, Singapore

    Bingwen Eugene Fan

  5. Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Level 9, 1E Kent Ridge Road, Singapore, 119228, Singapore

    Graeme MacLaren & Kollengode Ramanathan

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Contributions

Study design: SM, KR. Search strategy and screening of articles: JJLS, RRL, SM, KR. Risk of bias assessment: JJLS, RRL. Data collection: JJLS, RRL, SM. Data analysis and interpretation: JJLS, CST, KR. Tables and figures: JJLS. Drafting of manuscript: JJLS, SM, RRL, KR. Critical revision of manuscript for intellectually important content: JJLS, SM, RRL, CST, BEF, GM, KR. All authors provided critical conceptual input, interpreted the data analysis, read, and approved the final draft.

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Correspondence to Kollengode Ramanathan.

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Sim, J.J.L., Mitra, S., Ling, R.R. et al. Extracorporeal membrane oxygenation in patients with hematologic malignancies: a systematic review and meta-analysis. Ann Hematol 101, 1395–1406 (2022). https://doi.org/10.1007/s00277-022-04855-2

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  • DOI: https://doi.org/10.1007/s00277-022-04855-2

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