Continuous infusion chemotherapy, radiotherapy, and FDG‐PET are feasible during extracorporeal membrane oxygenation

Abstract

Extracorporeal membrane oxygenation (ECMO) may be used in extreme circumstances for patients with a mediastinal mass and respiratory failure. We report on a young man with primary mediastinal B‐cell lymphoma invading into the trachea, requiring a 40‐day ECMO run who underwent fluorodeoxyglucose positron emission tomography (FDG‐PET) imaging and treatment with concurrent mediastinal irradiation and continuous infusion chemotherapy while on this life‐saving technology. This case illustrates that oncology patients may be managed by multidisciplinary teams for extended periods in extraordinary circumstances using multimodality therapies. Additionally, to our knowledge this is the first case to demonstrate the feasibility of FDG‐PET imaging while on ECMO.

Airway Emergencies Due to Anterior Mediastinal T-Lymphoblastic Lymphoma Managed With Planned Extracorporeal Membrane Oxygenation and Endotracheal Stent: A Case Report and Literature Review

“…Table 1 summarizes the cases of ECMO in patients with hematological malignancies of the anterior mediastinal [5][6][7][8][9][10][11][12][13][14][15], including the present case, focusing on the intensive care period, airway management, and complications. The stenosis site extended from the lower part of the trachea to the bifurcation or the main bronchus in all cases, suggesting that ECMO introduction might be needed when respiratory management is difficult.…”

Malignant Central Airway Obstruction: What's New?

“…8). [143][144][145][146] The decision to offer or initiate ECMO in patients with MCAO should be multifactorial and interdisciplinary, considering the amenability of CAO to bronchoscopic intervention, availability of proceduralists with experience in the management of CAO, anticipated response to other local or systemic therapies, medical comorbidities, and overall prognosis. Given what is known regarding the outcomes of patients with MCAO, coupled with our knowledge regarding the use of ECLS for respiratory failure due to advanced neoplastic disease, many clinicians understandably perceive the ultimate futility in initiating ECMO when such individuals reach a point in their illness where starting extracorporeal support is a matter of life and death.…”

“…The patient received radiation therapy and chemotherapy, resulting in steady improvements in luminal patency and tumor-burden (D-I). He was successfully decannulated from ECMO after 40 days and subsequently discharged from the hospital (Reproduced with permission from Rotz, et al145 ).…”

Pediatric oncology—The final frontier for extracorporeal membrane oxygenation in children?

“…[6][7][8] In this issue of the journal, two studies illustrate the potential for successful management of complex children with oncological disease or following hemopoietic stem cell transplantation (HSCT) for other diagnoses. 9,10 In the larger study, Steppan and colleagues leverage multicenter data from the granular Pediatric ECMO Outcomes Registry (PEDECOR, a collaboration within the Pediatric Acute Lung Injury and Sepsis Investigators, PALISI Network), 11 to describe a cohort of children with oncological diagnoses and/or HSCT treatment who were managed on ECMO. 10 The premise of this analysis is the widening indications for ECMO cannulation without empiric evidence of benefits and harms in this population.…”

“…Building on the ECMO support theme in a descriptive short report, Rotz and colleagues describe the management of a patient resuscitated with VA-ECMO for cardiorespiratory failure secondary to complications during management of central airway compression by a mediastinal mass, later converted to VV-ECMO for ongoing respiratory support. 9 The patient was diagnosed with primary mediastinal B-cell lymphoma (PMBCL) and required infusions of chemotherapeutic agents, radiotherapy, sophisticated imaging modalities, and tracheostomy during the ECMO run. The rapid response, multidisciplinary coordinated care, and evolution of support to best target underlying pathophysiology described would be expected from an experienced ECMO program.…”