Skip to main content
SpringerLink
Log in

Extracorporeal Membrane Oxygenation (ECMO) Critically Ill Cancer Patients

  • Living reference work entry
  • First Online:
Book cover Oncologic Critical Care

Abstract

As prognosis of critically ill cancer patients has markedly improved during the last decades, a general reluctance to admit critically ill cancer patients to the ICU cannot be justified anymore. This development leads to an increasing number of patients classified as prone to “full code management” which refers to the use of the whole armamentarium of intensive care medicine, comprising also respiratory or circulatory support by ECMO, if applicable. The term “ECMO” refers to either respiratory or circulatory support. As respiratory failure is the leading cause for ICU admission in cancer patients and is associated with high mortality, respiratory ECMO has been mainly used in selected patients suffering from severe pneumonia, ARDS, diffuse alveolar hemorrhage, or involvement of the respiratory system by the underlying disease. General ECMO indication criteria also apply to cancer patients, provided that the status of the underlying malignancy allows for “full code” intensive care management. Outcome of critically ill cancer patients in need for ECMO is however worse compared to patients not suffering from malignancy. There are no defined criteria for predicting prognosis; it seems to be prudent, however, to prefer ECMO in patients in need for a therapeutic bridge to overcome a reversible acute and life-threatening complication. Patients undergoing hematopoietic stem cell transplantation are no good candidates for ECMO therapy during the peri-transplant period due to very poor outcome. Management of cancer patients during ECMO can be challenging due to immunosuppression leading to an increased risk for infectious complications as well as due to an increased risk for bleeding complications due to thrombocytopenia or derangements of plasmatic coagulation. An individually tailored anticoagulation concept should therefore be applied. If prerequisites for successful management cease to apply, withdrawal of care will be appropriate. In this situation, a clear communication strategy and adequate palliative care measures should be applied in a standardized way.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Azoulay E, et al. 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. 2013;31:2810–8. https://doi.org/10.1200/JCO.2012.47.2365.

    Article  PubMed  Google Scholar 

  2. Azoulay E, Afessa B. The intensive care support of patients with malignancy: do everything that can be done. Intensive Care Med. 2006;32:3–5. https://doi.org/10.1007/s00134-005-2835-6.

    Article  PubMed  Google Scholar 

  3. Lecuyer L, Chevret S, Thiery G, Darmon M, Schlemmer B, Azoulay E. The ICU trial: a new admission policy for cancer patients requiring mechanical ventilation. Crit Care Med. 2007;35:808–14. https://doi.org/10.1097/01.CCM.0000256846.27192.7A.

    Article  PubMed  Google Scholar 

  4. Barbaro RP, Odetola FO, Kidwell KM, Paden ML, Bartlett RH, Davis MM, Annich GM. Association of hospital-level volume of extracorporeal membrane oxygenation cases and mortality. Analysis of the extracorporeal life support organization registry. Am J Respir Crit Care Med. 2015;191:894–901. https://doi.org/10.1164/rccm.201409-1634OC.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Lecuyer L, Chevret S, Guidet B, Aegerter P, Martel P, Schlemmer B, Azoulay E. Case volume and mortality in haematological patients with acute respiratory failure. Eur Respir J. 2008;32:748–54. https://doi.org/10.1183/09031936.00142907.

    Article  CAS  PubMed  Google Scholar 

  6. Zuber B, et al. Impact of case volume on survival of septic shock in patients with malignancies. Crit Care Med. 2012;40:55–62. https://doi.org/10.1097/CCM.0b013e31822d74ba.

    Article  PubMed  Google Scholar 

  7. Ranieri VM, Brodie D, Vincent JL. Extracorporeal organ support: from technological tool to clinical strategy supporting severe organ failure. JAMA. 2017;318:1105–6. https://doi.org/10.1001/jama.2017.10108.

    Article  PubMed  Google Scholar 

  8. Hermann A, et al. A novel pump-driven veno-venous gas exchange system during extracorporeal CO2-removal. Intensive Care Med. 2015;41: 1773–80. https://doi.org/10.1007/s00134-015-3957-0.

    Article  CAS  PubMed  Google Scholar 

  9. Schmidt M, et al. Blood oxygenation and decarboxylation determinants during venovenous ECMO for respiratory failure in adults. Intensive Care Med. 2013;39:838–46. https://doi.org/10.1007/s00134-012-2785-8.

    Article  CAS  PubMed  Google Scholar 

  10. Hoeper MM, et al. Extracorporeal membrane oxygenation watershed. Circulation. 2014;130:864–5. https://doi.org/10.1161/CIRCULATIONAHA.114.011677.

    Article  PubMed  Google Scholar 

  11. ELSO. Adult respiratory failure guideline. 2017. https://www.elso.org/Portals/0/ELSO%20Guidelines%20For%20Adult%20Respiratory%20Failure%201_4.pdf

  12. ELSO. Guidelines for adult cardiac failure. 2017. https://www.elso.org/Portals/0/IGD/Archive/FileManager/e76ef78eabcusersshyerdocumentselsoguidelinesforadultcardiacfailure13.pdf

  13. Peek GJ, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet. 2009;374:1351–63. https://doi.org/10.1016/S0140-6736(09)61069-2.

    Article  PubMed  Google Scholar 

  14. Combes A, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med. 2018;378:1965–75. https://doi.org/10.1056/NEJMoa1800385.

    Article  PubMed  Google Scholar 

  15. Muller G, et al. The ENCOURAGE mortality risk score and analysis of long-term outcomes after VA-ECMO for acute myocardial infarction with cardiogenic shock. Intensive Care Med. 2016;42:370–8. https://doi.org/10.1007/s00134-016-4223-9.

    Article  PubMed  Google Scholar 

  16. Schmidt M, et al. Predicting survival after ECMO for refractory cardiogenic shock: the survival after veno-arterial-ECMO (SAVE)-score. Eur Heart J. 2015;36:2246–56. https://doi.org/10.1093/eurheartj/ehv194.

    Article  CAS  PubMed  Google Scholar 

  17. Fagnoul D, Combes A, De Backer D. Extracorporeal cardiopulmonary resuscitation. Curr Opin Crit Care. 2014;20:259–65. https://doi.org/10.1097/MCC.0000000000000098.

    Article  PubMed  Google Scholar 

  18. Lamhaut L, et al. A pre-hospital extracorporeal cardio pulmonary resuscitation (ECPR) strategy for treatment of refractory out hospital cardiac arrest: an observational study and propensity analysis. Resuscitation. 2017;117:109–17. https://doi.org/10.1016/j.resuscitation.2017.04.014.

    Article  PubMed  Google Scholar 

  19. Gow KW, Lao OB, Leong T, Fortenberry JD. Extracorporeal life support for adults with malignancy and respiratory or cardiac failure: The Extracorporeal Life Support experience. Am J Surg. 2010;199:669–75. https://doi.org/10.1016/j.amjsurg.2010.01.018.

    Article  PubMed  Google Scholar 

  20. Kang HS, Rhee CK, Lee HY, Kim YK, Kwon SS, Kim SC, Lee JW. Clinical outcomes of extracorporeal membrane oxygenation support in patients with hematologic malignancies. Korean J Intern Med. 2015;30:478–88. https://doi.org/10.3904/kjim.2015.30.4.478.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Wohlfarth P, et al. Extracorporeal membrane oxygenation in adult patients with hematologic malignancies and severe acute respiratory failure. Crit Care. 2014;18:R20. https://doi.org/10.1186/cc13701.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Schmidt M, et al. Six-month outcome of immunocompromised severe ARDS patients rescued by ECMO. An International Multicenter Retrospective Study. Am J Respir Crit Care Med. 2018; https://doi.org/10.1164/rccm.201708-1761OC.

    Article  CAS  Google Scholar 

  23. Huynh TN, Weigt SS, Belperio JA, Territo M, Keane MP. Outcome and prognostic indicators of patients with hematopoietic stem cell transplants admitted to the intensive care unit. J Transp Secur. 2009;2009: 917294. https://doi.org/10.1155/2009/917294.

    Article  Google Scholar 

  24. Lengline E, et al. Changes in intensive care for allogeneic hematopoietic stem cell transplant recipients. Bone Marrow Transplant. 2015;50:840–5. https://doi.org/10.1038/bmt.2015.55.

    Article  CAS  PubMed  Google Scholar 

  25. Mokart D, et al. Allogeneic hematopoietic stem cell transplantation after reduced intensity conditioning regimen: Outcomes of patients admitted to intensive care unit. J Crit Care. 2015;30:1107–13. https://doi.org/10.1016/j.jcrc.2015.06.020.

    Article  PubMed  Google Scholar 

  26. Afessa B, Azoulay E. Critical care of the hematopoietic stem cell transplant recipient. Crit Care Clin. 2010;26:133–50. https://doi.org/10.1016/j.ccc.2009.09.001.

    Article  CAS  PubMed  Google Scholar 

  27. Yadav H, et al. Epidemiology of acute respiratory distress syndrome following hematopoietic stem cell transplantation. Crit Care Med. 2016;44:1082–90. https://doi.org/10.1097/CCM.0000000000001617.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Di Nardo M, et al. Extracorporeal membrane oxygenation in pediatric recipients of hematopoietic stem cell transplantation: an updated analysis of the Extracorporeal Life Support Organization experience. Intensive Care Med. 2014;40:754–6. https://doi.org/10.1007/s00134-014-3240-9.

    Article  PubMed  Google Scholar 

  29. Wohlfarth P, et al. Characteristics and outcome of patients after allogeneic hematopoietic stem cell transplantation treated with extracorporeal membrane oxygenation for acute respiratory distress syndrome. Crit Care Med. 2017;45:e500–7. https://doi.org/10.1097/CCM.0000000000002293.

    Article  PubMed  Google Scholar 

  30. Murray JF, Matthay MA, Luce JM, Flick MR. An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis. 1988;138:720–3. https://doi.org/10.1164/ajrccm/138.3.720.

    Article  CAS  PubMed  Google Scholar 

  31. Aboud A, Marx G, Sayer H, Gummert JF. Successful treatment of an aggressive non-Hodgkin's lymphoma associated with acute respiratory insufficiency using extracorporeal membrane oxygenation. Interact Cardiovasc Thorac Surg. 2008;7:173–4. https://doi.org/10.1510/icvts.2007.159921.

    Article  PubMed  Google Scholar 

  32. Oto M, Inadomi K, Chosa T, Uneda S, Uekihara S, Yoshida M. Successful use of extracorporeal membrane oxygenation for respiratory failure caused by mediastinal precursor T lymphoblastic lymphoma. Case Rep Med. 2014;2014:804917. https://doi.org/10.1155/2014/804917.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Rateesh S, Shekar K, Naidoo R, Mittal D, Bhaskar B. Use of extracorporeal membrane oxygenation for mechanical circulatory support in a patient with 5-fluorouracil induced acute heart failure. Circ Heart Fail. 2015;8:381–3. https://doi.org/10.1161/CIRCHEARTFAILURE.115.002080.

    Article  PubMed  Google Scholar 

  34. Kaese S, Schulke C, Fischer D, Lebiedz P. Pheochromocytoma-induced takotsubo-like cardiomyopathy and global heart failure with need for extracorporal life support. Intensive Care Med. 2013;39:1473–4. https://doi.org/10.1007/s00134-013-2942-8.

    Article  PubMed  Google Scholar 

  35. Kurakazu M, Ueda T, Matsuo K, Ishikura H, Kumagai N, Yoshizato T, Miyamoto S. Percutaneous cardiopulmonary support for pulmonary thromboembolism caused by large uterine leiomyomata. Taiwan J Obstet Gynecol. 2012;51:639–42. https://doi.org/10.1016/j.tjog.2012.09.023.

    Article  PubMed  Google Scholar 

  36. Chung JH, et al. Treatment of pulmonary tumor embolism from choriocarcinoma: extracorporeal membrane oxygenation as a bridge through chemotherapy. Cancer Res Treat. 2017;49:279–82. https://doi.org/10.4143/crt.2016.125.

    Article  PubMed  Google Scholar 

  37. Brechot N, et al. Venoarterial extracorporeal membrane oxygenation support for refractory cardiovascular dysfunction during severe bacterial septic shock. Crit Care Med. 2013;41:1616–26. https://doi.org/10.1097/CCM.0b013e31828a2370.

    Article  CAS  PubMed  Google Scholar 

  38. Huang CT, Tsai YJ, Tsai PR, Ko WJ. Extracorporeal membrane oxygenation resuscitation in adult patients with refractory septic shock. J Thorac Cardiovasc Surg. 2013;146:1041–6. https://doi.org/10.1016/j.jtcvs.2012.08.022.

    Article  PubMed  Google Scholar 

  39. Park TK, et al. Extracorporeal membrane oxygenation for refractory septic shock in adults. Eur J Cardiothorac Surg. 2015;47:e68–74. https://doi.org/10.1093/ejcts/ezu462.

    Article  PubMed  Google Scholar 

  40. Abrams D, Agerstrand CL, Biscotti M, Burkart KM, Bacchetta M, Brodie D. Extracorporeal membrane oxygenation in the management of diffuse alveolar hemorrhage. ASAIO J. 2015;61:216–8. https://doi.org/10.1097/MAT.0000000000000183.

    Article  CAS  PubMed  Google Scholar 

  41. Lee JH, Kim SW. Successful management of warfarin-exacerbated diffuse alveolar hemorrhage using an extracorporeal membrane oxygenation. Multidiscip Respir Med. 2013;8:16. https://doi.org/10.1186/2049-6958-8-16.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Aubron C, et al. Predictive factors of bleeding events in adults undergoing extracorporeal membrane oxygenation. Ann Intensive Care. 2016;6:97. https://doi.org/10.1186/s13613-016-0196-7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Thiagarajan RR, et al. Extracorporeal life support organization registry international report 2016. ASAIO J. 2017;63:60–7. https://doi.org/10.1097/MAT.0000000000000475.

    Article  PubMed  Google Scholar 

  44. Vaquer S, de Haro C, Peruga P, Oliva JC, Artigas A. Systematic review and meta-analysis of complications and mortality of veno-venous extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome. Ann Intensive Care. 2017;7:51. https://doi.org/10.1186/s13613-017-0275-4.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Zangrillo A, et al. A meta-analysis of complications and mortality of extracorporeal membrane oxygenation. Crit Care Resusc. 2013;15:172–8.

    PubMed  Google Scholar 

  46. ELSO. ELSO anticoagulation guideline. 2014. https://www.elso.org/Portals/0/Files/elsoanticoagulationguideline8-2014-table-contents.pdf

  47. Liveris A, et al. Anti-factor Xa assay is a superior correlate of heparin dose than activated partial thromboplastin time or activated clotting time in pediatric extracorporeal membrane oxygenation*. Pediatr Crit Care Med. 2014;15:e72–9. https://doi.org/10.1097/PCC.0000000000000028.

    Article  PubMed  Google Scholar 

  48. Yeo HJ, Kim DH, Jeon D, Kim YS, Cho WH. Low-dose heparin during extracorporeal membrane oxygenation treatment in adults. Intensive Care Med. 2015;41:2020–1. https://doi.org/10.1007/s00134-015-4015-7.

    Article  PubMed  Google Scholar 

  49. Krueger K, Schmutz A, Zieger B, Kalbhenn J. Venovenous extracorporeal membrane oxygenation with prophylactic subcutaneous anticoagulation only: an observational study in more than 60 patients. Artif Organs. 2017;41:186–92. https://doi.org/10.1111/aor.12737.

    Article  CAS  PubMed  Google Scholar 

  50. Muellenbach RM, et al. Prolonged heparin-free extracorporeal membrane oxygenation in multiple injured acute respiratory distress syndrome patients with traumatic brain injury. J Trauma Acute Care Surg. 2012;72:1444–7. https://doi.org/10.1097/TA.0b013e31824d68e3.

    Article  PubMed  Google Scholar 

  51. Herbert DG, Buscher H, Nair P. Prolonged venovenous extracorporeal membrane oxygenation without anticoagulation: a case of Goodpasture syndrome-related pulmonary haemorrhage. Crit Care Resusc. 2014;16: 69–72.

    PubMed  Google Scholar 

  52. Kasirajan V, Smedira NG, McCarthy JF, Casselman F, Boparai N, McCarthy PM. Risk factors for intracranial hemorrhage in adults on extracorporeal membrane oxygenation. Eur J Cardiothorac Surg. 1999;15: 508–14.

    Article  CAS  Google Scholar 

  53. Luyt CE, et al. Brain injury during venovenous extracorporeal membrane oxygenation. Intensive Care Med. 2016;42:897–907. https://doi.org/10.1007/s00134-016-4318-3.

    Article  CAS  PubMed  Google Scholar 

  54. Schmidt M, et al. Mechanical ventilation management during extracorporeal membrane oxygenation for acute respiratory distress syndrome: a retrospective international multicenter study. Crit Care Med. 2015;43:654–64. https://doi.org/10.1097/CCM.0000000000000753.

    Article  CAS  PubMed  Google Scholar 

  55. Serpa Neto A, et al. Associations between ventilator settings during extracorporeal membrane oxygenation for refractory hypoxemia and outcome in patients with acute respiratory distress syndrome: a pooled individual patient data analysis: mechanical ventilation during ECMO. Intensive Care Med. 2016;42: 1672–84. https://doi.org/10.1007/s00134-016-4507-0.

    Article  CAS  PubMed  Google Scholar 

  56. Hoeper MM, et al. Extracorporeal membrane oxygenation instead of invasive mechanical ventilation in patients with acute respiratory distress syndrome. Intensive Care Med. 2013;39:2056–7. https://doi.org/10.1007/s00134-013-3052-3.

    Article  PubMed  Google Scholar 

  57. Herridge MS, et al. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011;364:1293–304. https://doi.org/10.1056/NEJMoa1011802.

    Article  CAS  PubMed  Google Scholar 

  58. Schmidt M, et al. The PRESERVE mortality risk score and analysis of long-term outcomes after extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. Intensive Care Med. 2013;39: 1704–13. https://doi.org/10.1007/s00134-013-3037-2.

    Article  CAS  PubMed  Google Scholar 

  59. Schweickert WD, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373:1874–82. https://doi.org/10.1016/S0140-6736(09)60658-9.

    Article  PubMed  Google Scholar 

  60. Schaller SJ, et al. Early, goal-directed mobilisation in the surgical intensive care unit: a randomised controlled trial. Lancet. 2016;388:1377–88. https://doi.org/10.1016/S0140-6736(16)31637-3.

    Article  PubMed  Google Scholar 

  61. Wells CL, Forrester J, Vogel J, Rector R, Tabatabai A, Herr D. Safety and feasibility of early physical therapy for patients on extracorporeal membrane oxygenator: University of Maryland medical center experience. Crit Care Med. 2018;46:53–9. https://doi.org/10.1097/CCM.0000000000002770.

    Article  PubMed  Google Scholar 

  62. Abrams D, et al. Early mobilization of patients receiving extracorporeal membrane oxygenation: a retrospective cohort study. Crit Care. 2014;18:R38. https://doi.org/10.1186/cc13746.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Fuehner T, et al. Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation. Am J Respir Crit Care Med. 2012;185:763–8. https://doi.org/10.1164/rccm.201109-1599OC.

    Article  PubMed  Google Scholar 

  64. Benoit DD, et al. Outcome in severely ill patients with hematological malignancies who received intravenous chemotherapy in the intensive care unit. Intensive Care Med. 2006;32:93–9. https://doi.org/10.1007/s00134-005-2836-5.

    Article  PubMed  Google Scholar 

  65. Wohlfarth P, et al. Prognostic factors, long-term survival, and outcome of cancer patients receiving chemotherapy in the intensive care unit. Ann Hematol. 2014;93:1629–36. https://doi.org/10.1007/s00277-014-2141-x.

    Article  CAS  PubMed  Google Scholar 

  66. Shekar K, Fraser JF, Smith MT, Roberts JA. Pharmacokinetic changes in patients receiving extracorporeal membrane oxygenation. J Crit Care. 2012;27:741 e749–18. https://doi.org/10.1016/j.jcrc.2012.02.013.

    Article  CAS  Google Scholar 

  67. Slatore CG, et al. Intensive care unit outcomes among patients with lung cancer in the surveillance, epidemiology, and end results-medicare registry. J Clin Oncol. 2012;30:1686–91. https://doi.org/10.1200/JCO.2011.40.0846.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine I, Intensive Care Unit, Medical University of Vienna, Vienna General Hospital, Vienna, Austria

    Thomas Staudinger, Peter Schellongowski & Philipp Wohlfarth

Authors
  1. Thomas Staudinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peter Schellongowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Philipp Wohlfarth
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thomas Staudinger .

Editor information

Editors and Affiliations

  1. Department of Critical Care, University of Texas MD Anderson Cancer C Department of Critical Care, Houston, TX, USA

    Joseph L. Nates

  2. Department of Critical Care, University of Texas MD Anderson Cancer C Department of Critical Care, Houston, TX, USA

    Kristen J. Price

Section Editor information

  1. Critical Care Department, Universidad del Rosario Hospital Universitario Fundacion Santa Fe de, Bogota, Colombia, Colombia

    Yenny Cardenas

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Staudinger, T., Schellongowski, P., Wohlfarth, P. (2019). Extracorporeal Membrane Oxygenation (ECMO) Critically Ill Cancer Patients. In: Nates, J., Price, K. (eds) Oncologic Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-74698-2_60-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-74698-2_60-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74698-2

  • Online ISBN: 978-3-319-74698-2

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation