Mortality Trends of Oncology and Hematopoietic Stem Cell Transplant Patients Supported on Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis

Abstract

Background: There is an increasing frequency of oncology and hematopoietic stem cell transplant (HSCT) patients seen in the intensive care unit and requiring extracorporeal membrane oxygenation (ECMO), however, prognosis of this population over time is unclear. Methods: MEDLINE, EMBASE, Cochrane and Web of Science were searched from earliest publication until April 10, 2020 for studies to determine the mortality trend over time in oncology and HSCT patients requiring ECMO. Primary outcome was hospital mortality. Random-effects meta-analysis model was used to obtain pooled estimates of mortality and 95% confidence intervals. A priori subgroup metanalysis compared adult versus pediatric, oncology versus HSCT, hematological malignancy versus solid tumor, allogeneic versus autologous HSCT, and veno-arterial versus veno-venous ECMO populations. Multivariable meta-regression was also performed for hospital mortality to account for year of study and HSCT population. Results: 17 eligible observational studies (n = 1109 patients) were included. Overall pooled hospital mortality was 72% (95% CI: 65, 78). In the subgroup analysis, only HSCT was associated with a higher hospital mortality compared to oncology subgroup [84% (95% CI: 70, 93) vs. 66% (95% CI: 56, 74); P = 0.021]. Meta-regression showed that HSCT was associated with increased mortality [adjusted odds ratio (aOR) 3.84 (95% CI 1.77, 8.31)], however, mortality improved with time [aOR 0.92 (95% CI: 0.85, 0.99) with each advancing year]. Conclusion: This study reports a high overall hospital mortality in oncology and HSCT patients on ECMO which improved over time. The presence of HSCT portends almost a 4-fold increased risk of mortality and this finding may need to be taken into consideration during patient selection for ECMO.

Why do children not survive extracorporeal membrane oxygenation?

“…16 Although prognosis is poor, there is a trend towards improved survival for children with malignancy and BMT who receive ECMO. 17 Indications for ECMO among these children are likely to expand as advancements are made. Despite the 100% mortality rate, in albeit a small subgroup, described in our cohort, ECMO may still be a viable treatment option for some of these children in the future.…”

Tickle Me ECMO…Differences and Outcomes Unearthed for Kids Requiring Extracorporeal Membrane Oxygenation in Severe Acute Respiratory Syndrome Coronavirus 2–Associated Disease*

“…group had an oncologic diagnosis or immune compromise, which is a population with historically poor survival with mechanical support (12). The aggregate of this data informs clinicians that MIS-C patients with refractory cardiogenic shock can have good outcomes when supported by ECMO, especially with venoarterial ECMO.…”

“…These patients had an overall low mortality rate compared to other diagnoses requiring venoarterial ECMO; very similar to the mortality rate in myocarditis (10, 11). Furthermore, 11% of patients in the MIS-C ECMO group had an oncologic diagnosis or immune compromise, which is a population with historically poor survival with mechanical support (12). The aggregate of this data informs clinicians that MIS-C patients with refractory cardiogenic shock can have good outcomes when supported by ECMO, especially with venoarterial ECMO.…”

Extracorporeal membrane oxygenation in long-term COVID-19 with severe neutropenia and thrombocytopenia after allogeneic hematopoietic stem cell transplantation: a case report

“…The complexity of HSCT and the critical presentation of ARDS made it difficult for these patients to benefit from ECMO therapy [ 1 , 2 ]. The in-hospital mortality for HSCT patients using ECMO was significantly higher than those who did not receive HSCT [ 3 – 5 ]. ECMO is a highly technical life-saving intervention, and given the resources required and the practical benefits gained, ECMO was rarely used in patients with HSCT.…”