Pediatric Hematology and Oncology Patients on Extracorporeal Membrane Oxygenation: Outcomes in a Multicenter, Retrospective Cohort, 2009-2021.

Objective: To describe characteristics associated with survival for pediatric patients with an oncologic diagnosis or hematopoietic cell transplant (HCT) supported with extracorporeal membrane oxygenation (ECMO).
Design: Multicenter, retrospective study.
Setting: Sixteen PICUs in the United States and Israel.
Patients: We included patients aged younger than 19 years with an oncologic diagnosis or HCT who required ECMO support between 2009 and 2021.
Interventions: None.
Measurements and Main Results: A total of 149 patients were included in the study cohort. There were 118 patients with an oncologic diagnosis and 31 that received HCT. The indications for ECMO were respiratory failure (46%), combined respiratory and cardiac failure (28%), and cardiac failure (25%). Venovenous (V-V) ECMO was used in 45% of patients, with 53% of patients being placed on venoarterial (V-A) ECMO. For oncologic and HCT groups, survival to ECMO decannulation was 52% (62/118) and 64% (20/31), and survival to hospital discharge was 36% (43/118) and 42% (13/31), respectively. After adjusting for other factors, requiring cardiopulmonary resuscitation was associated with greater odds ratio of mortality (3.0 [95% CI, 1.2-7.7]).
Conclusions: Survival to ECMO decannulation of pediatric oncologic and HCT patients in this study was 52-64%, depending upon diagnosis. However, survival to hospital discharge remains poor. Future research should prioritize understanding factors contributing to this survival gap within these patient populations.
Competing Interests: Dr. Mowrer received funding from the Extracorporeal Life Support Organization (ELSO). Drs. Nair and Potera’s institutions received funding from ELSO. Dr. Li disclosed work for hire. Dr. Barbaro’s institution received funding from the National Institutes of Health (NIH) (R01 HL153519); they disclosed they are a member of the ELSO Board of Directors and a member of pediatric extracorporeal membrane oxygenation (ECMO); they disclosed off-label use of ECMO. Dr. Barbaro is a board member for the ELSO and reports funding from the NIH (R01 HL153519). Dr. Zinter received support for article research from the NIH. Dr. Nkwantabisa received funding from Medtronic. The remaining authors have disclosed that they do not have any potential conflicts of interest.
(Copyright © 2024 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)