Pediatric Hematopoietic Stem Cell Transplant and Intensive Care

Balit, Corrine R; Horan, Rachael; Dorofaeff, Tavey; Frndova, Helena; Doyle, John; Cox, Peter N.

doi:10.1097/pcc.0000000000000607

Cited by 30 publications

(44 citation statements)

References 15 publications

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“…In our study, cases and controls had similar rates of intubation for at least four hours pre‐ECMO, and no significant difference in OI. Additional risk factors for mortality in other studies included lower PaO 2 before ECLS, need for inotrope support (non‐ECMO), 13,41,48,49 and duration of ICU admission prior to intubation 44 . However, none of these variables at the time of cannulation were significantly different between cases and controls in our report.…”

Section: Discussioncontrasting

confidence: 53%

Outcomes of pediatric patients with oncologic disease or following hematopoietic stem cell transplant supported on extracorporeal membrane oxygenation: The PEDECOR experience

Steppan

Coleman

Viamonte

et al. 2020

Pediatric Blood & Cancer

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Background Outcomes for patients with oncologic disease and/or after hematopoietic stem cell transplant (HSCT) requiring intensive care unit admission have improved, but indications for and outcomes after extracorporeal membrane oxygenation (ECMO) support in this population are poorly characterized. Procedure We analyzed data from consecutive patients < 18 years with oncologic disease and/or after HSCT reported to a pediatric ECMO registry by nine pediatric centers in the United States between 2011 and 2018. Results We identified 18 ECMO patients with oncologic disease and/or HSCT, and 415 ECMO controls matched with a propensity score algorithm based on age, gender, race, severity of illness at admission, and reason for ECMO. The primary indication for ECMO was respiratory failure in 66.7% in the oncologic disease and/or HSCT group, and in 70.7% in the matched ECMO control group. Eleven of 18 patients survived to hospital discharge (61.1%), similar to the matched control group (60.8%), P = 0.979. Children with oncologic disease and/or HSCT had lower mean platelet counts during ECMO and received higher volumes of platelets compared with the control group, mean 14.6 mL/kg/day (standard deviations [SD], 9.8) versus mean 9.3 mL/kg/day (SD, 10.4), P = 0.001. Of the 11 surviving children with oncologic disease and/or HSCT, five sustained new neurologic disorders (45.5%) versus 45 of 222 (20.3%) in the control group, P = 0.061. Bleeding complications were similar in the two groups. Conclusions Outcomes of patients with oncologic disease and/or HSCT supported on ECMO in the current era are not significantly different compared with matched ECMO controls and are improved from previously published reports.

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Section: Discussioncontrasting

confidence: 53%

Outcomes of pediatric patients with oncologic disease or following hematopoietic stem cell transplant supported on extracorporeal membrane oxygenation: The PEDECOR experience

Steppan

Coleman

Viamonte

et al. 2020

Pediatric Blood & Cancer

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“…However, undergoing HSCT is confirmed to be a risk factor for mortality among this subset of patients [1,2]. Recent studies have reported that outcomes for these patients have improved over the course of years because of PICU technical advances (eg, noninvasive ventilation [NIV] and high-flow oxygen therapy [HFOT]) and improvements in supportive treatment during HSCT [1,[3][4][5][6]. Nevertheless, the mortality rate is still high, especially when invasive ventilation (IV) and continuous renal replacement therapy are needed.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors and Outcomes Related to Pediatric Intensive Care Unit Admission after Hematopoietic Stem Cell Transplantation: A Single-Center Experience

Pillon

Amigoni

Contin

et al. 2017

Biology of Blood and Marrow Transplantation

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To describe incidence, causes, and outcomes related to pediatric intensive care unit (PICU) admission for patients undergoing hematopoietic stem cell transplantation (HSCT), we investigated the risk factors predisposing to PICU admission and prognostic factors in terms of patient survival. From October 1998 to April 2015, 496 children and young adults (0 to 23 years) underwent transplantation in the HSCT unit. Among them, 70 (14.1%) were admitted to PICU. The 3-year cumulative incidence of PICU admission was 14.3%. The main causes of PICU admission were respiratory failure (36%), multiple organ failure (16%), and septic shock (13%). The overall 90-day cumulative probability of survival after PICU admission was 34.3% (95% confidence interval, 24.8% to 47.4%). In multivariate analysis, risk factors predisposing to PICU admission were allogeneic HSCT (versus autologous HSCT, P = .030) and second or third HSCT (P = .018). Characteristics significantly associated with mortality were mismatched HSCT (P = .011), relapse of underlying disease before PICU admission (P < .001), acute respiratory distress syndrome at admission (P = .012), hepatic failure at admission (P = .021), and need for invasive ventilation during PICU course (P < .001). Our data indicate which patients have a high risk for PICU admission after HSCT and for dismal outcomes after PICU stay. These findings may provide support for the clinical decision-making process on the opportunity of PICU admission for severely compromised patients after HSCT.

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“…A proportion of 10-20% of children undergoing haemopoietic stem cell transplantation (HSCT) need to be hospitalized in an intensive care unit (ICU) as a result of life-threatening complications (e.g., pulmonary), infections, or graft-vs-host disease. It has been reported that patients surviving after an ICU admission during the transplantation process have a low survival rate in the long run, particularly if they received prolonged mechanical ventilation (e.g., 36% following ICU discharge) [1]. As a result of this low survival rate and the frailty of many hematology-oncology (HO) patients, ICU teams may consider HSCT with mixed feelings with regards to its necessity and associated concerns.…”

Section: Dear Editormentioning

confidence: 99%

A comparison of attitudes toward HSCT and survival estimations post HSCT across two pediatric Hematology–Oncology and Intensive Care departments in Canada

Sultan

Vachon

Charette

et al. 2018

Bone Marrow Transplant

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Pediatric Hematopoietic Stem Cell Transplant and Intensive Care

Cited by 30 publications

References 15 publications

Outcomes of pediatric patients with oncologic disease or following hematopoietic stem cell transplant supported on extracorporeal membrane oxygenation: The PEDECOR experience

Outcomes of pediatric patients with oncologic disease or following hematopoietic stem cell transplant supported on extracorporeal membrane oxygenation: The PEDECOR experience

Risk Factors and Outcomes Related to Pediatric Intensive Care Unit Admission after Hematopoietic Stem Cell Transplantation: A Single-Center Experience

A comparison of attitudes toward HSCT and survival estimations post HSCT across two pediatric Hematology–Oncology and Intensive Care departments in Canada

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