Six-Month Outcome of Immunocompromised Patients with Severe Acute Respiratory Distress Syndrome Rescued by Extracorporeal Membrane Oxygenation. An International Multicenter Retrospective Study

Schmidt, Matthieu; Schellongowski, Peter; Patroniti, Nicolò; Taccone, Fabio Silvio; Miranda, Dinis Reis; Reuter, Jean; Prodanovic, Hélène; Pierrot, Marc; Dorget, Amandine; Park, Sunghoon; Borggrefe, Martin; Demoule, Alexandre; Crippa, Ilaria Alice; Mercat, Alain; Wohlfarth, Philipp; Sonneville, Romain; Combes, Alain; Bouadma, Lila; Timsit, Jean‐François; Brasseur, Alexandre; Lheureux, Olivier; Créteur, Jacques; Lemaître, Philippe; Bechtold, Xavier; Debeuckelaere, Gerdy; Partipilo, Franky; Thiel, Robert van; Uil, Corstiaan A. den; Rulíšek, Jan; Kopecký, P; Kunstýř, Jan; Bombino, Michela; Pizzagalli, Jonata; Ponti, Alessandro De; Pesenti, Antonio; Kim, Hyoung Soo; Luyt, Charles‐Édouard; Bréchot, Nicolas; Hékimian, Guillaume; Besset, Sébastien; Coutrot, Maxime; Nieszkowska, Ania; Bourcier, Simon; Lebreton, Guillaume; Leprince, Pascal; Mayaux, Julien; Bojic, Andja; Buchtele, Nina; Hermann, Alexander; Jaksch, Péter; Robak, Oliver; Sperr, Wolfgang R.; Staudinger, Thomas

doi:10.1164/rccm.201708-1761oc

Cited by 113 publications

(128 citation statements)

References 48 publications

Supporting

Mentioning

121

Contrasting

Order By: Relevance

“…Causes of pulmonary infiltrates in immunocompromised patients with acute respiratory failureMean percentage is reported in the first column in red for each cause, with 95% confidence intervals reported underneath. The study by Gruson and colleagues73 included only bone marrow transplant recipients and the studies by Wohlfarth and colleagues77 and Schmidt and colleagues78 included only patients with severe acute respiratory distress syndrome treated with extra-corporeal membrane oxygenation.…”

mentioning

confidence: 99%

Acute respiratory failure in immunocompromised adults

Azoulay

Mokart

Kouatchet

et al. 2019

The Lancet Respiratory Medicine

Self Cite

122

100

View full text Add to dashboard Cite

Acute respiratory failure occurs in up to half of patients with haematological malignancies and 15% of those with solid tumours or solid organ transplantation. Mortality remains high. Factors associated with mortality include a need for invasive mechanical ventilation, organ dysfunction, older age, frailty or poor performance status, delayed intensive care unit admission, and acute respiratory failure due to an invasive fungal infection or unknown cause. In addition to appropriate antibacterial therapy, initial clinical management aims to restore oxygenation and predict the most probable cause based on variables related to the underlying disease, acute respiratory failure characteristics, and radiographic findings. The cause of acute respiratory failure must then be confirmed using the most efficient, least invasive, and safest diagnostic tests. In patients with acute respiratory failure of undeter mined cause, a standardised diagnostic investi gation should be done immediately at admission before deciding whether to perform more invasive diagnostic procedures or to start empirical treatments. Collaborative and multidisciplinary clinical and research networks are crucial to improve our understanding of disease pathogenesis and causation and to develop less invasive diagnostic strategies and more targeted treatment options.www.thelancet.com/respiratory Vol

show abstract

mentioning

confidence: 99%

Acute respiratory failure in immunocompromised adults

Azoulay

Mokart

Kouatchet

et al. 2019

The Lancet Respiratory Medicine

Self Cite

122

100

View full text Add to dashboard Cite

show abstract

“…7 Moreover, in immunocompromised popula tions including patients with hematologic malignancies, low platelet count was shown to be an independent predictor of 6-month mortality. 20 Our report does not yield precise estimates and needs to be interpreted carefully. It should not be misinterpreted as advocating for the general use of ECMO in patients suffer ing from severe thrombocytopenia due to hematological malignancies or other conditions.…”

Section: Discussionmentioning

confidence: 72%

“…Typically, this exclusive patient population undergoes reluctant consideration for ECMO initiation as prognosis is unfavorable. 20 This reservation notwithstanding, highly selected cases such as the small population reported herein receive ECMO as a rescue strategy when recovery poten tial is conceivable at the time of decision. Therefore, in our hematology-affiliated intensive care unit, the number of patients fulfilling our entry criteria was as low as seven dur ing an observational period of just below four years.…”

Section: Discussionmentioning

confidence: 95%

“…Portraying the immunocompromised critically ill with coexisting thrombocytopenia and ECMO indication is challenging. Typically, this exclusive patient population undergoes reluctant consideration for ECMO initiation as prognosis is unfavorable . This reservation notwithstanding, highly selected cases such as the small population reported herein receive ECMO as a rescue strategy when recovery potential is conceivable at the time of decision.…”

Section: Discussionmentioning

confidence: 99%

“…Not incorporating platelet count may be an accountable explanation, since thrombocytopenia is regarded as a risk factor for intracranial hemorrhage and thus death . Moreover, in immunocompromised populations including patients with hematologic malignancies, low platelet count was shown to be an independent predictor of 6‐month mortality …”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

ECMO without anticoagulation in patients with disease‐related severe thrombocytopenia: Feasible but futile?

et al. 2019

Self Cite

View full text Add to dashboard Cite

Severe thrombocytopenia poses a high risk for bleeding thus representing a relative contraindication for anticoagulation and therefore extracorporeal membrane oxygenation (ECMO). We herein report on a series of immunocompromised patients with severe thrombocytopenia undergoing long‐term ECMO without systemic anticoagulation. We retrospectively identified seven adult patients with anticoagulation withdrawal for ≥3 days (range 5–317) during venovenous ECMO therapy due to thrombocytopenia < 50 G/L treated in a university‐affiliated hospital from January 2013 to April 2017. All ECMO systems used were heparin coated. Overall, 530 ECMO days were observed, 404 (76%) of them without systemic anticoagulation. Platelet count during ECMO treatment was 24 G/L (median, range 1‐138), ECMO duration was 35 days (5‐317), and ECMO was run without any anticoagulation for 20 days (5‐317). Altogether, five clotting events were seen leading to oxygenator exchanges. Bleeding was common including one fatal intracerebral hemorrhage. Altogether, 29 platelet concentrates per patient (7‐207) were administered, which correspond to 0.8 per day (0.6‐1.3). One patient survived ICU and hospital. In patients with thrombocytopenia, ECMO can be run without anticoagulation even for considerably long periods of time. Bleeding remains common, while clotting events seem to be rare. However, prognosis of this patient population undergoing ECMO support seems grim.

show abstract

ECMO Use in the Pediatric Immunocompromised Hematology/Oncology Patient

Niebler

Lehmann

2019

Critical Care of the Pediatric Immunocompromised Hematology/Oncology Patient

View full text Add to dashboard Cite

Six-Month Outcome of Immunocompromised Patients with Severe Acute Respiratory Distress Syndrome Rescued by Extracorporeal Membrane Oxygenation. An International Multicenter Retrospective Study

Cited by 113 publications

References 48 publications

Acute respiratory failure in immunocompromised adults

Acute respiratory failure in immunocompromised adults

ECMO without anticoagulation in patients with disease‐related severe thrombocytopenia: Feasible but futile?

ECMO Use in the Pediatric Immunocompromised Hematology/Oncology Patient

Contact Info

Product

Resources

About