Presenter Status
Fellow
Abstract Type
Research
Primary Mentor
Ásdís Finnsdóttir Wagner DO
Start Date
13-5-2021 12:15 PM
End Date
13-5-2021 12:30 PM
Presentation Type
Oral Presentation
Description
Background: The use of extracorporeal membrane oxygenation (ECMO) for support of pediatric patients has significantly increased in the past years. Patients with known oncologic diseases, immunodeficiencies, or bone marrow transplants (BMT) have traditionally not been considered candidates for Extracorporeal membrane oxygenation (ECMO) due to perceived high risk for mortality. Ongoing advances have continued to push the boundaries of ECMO use and we report our recent experience with this patient population
Objectives/Goal: To evaluate survival to discharge of pediatric patients who require ECMO support and who also have an underlying hematologic or oncologic disease process. To determine specific patient characteristics that would affect morbidity and mortality for this particular patient population. To evaluate the effects of concomitant support therapies, such as CRRT or total plasma exchange (TPE), on survival to discharge.
Methods/Design: Single center chart review cohort study involving 15 patients with a history of hematologic/oncologic diagnosis or bone marrow transplantation admitted to the PICU at Children’s Mercy Hospital between 2015 and 2020 and who required ECMO for respiratory or hemodynamic support.
Results: We identified 15 patients with ages raging between 3 weeks and 16 years of age with both hematologic and oncologic diagnoses who required ECMO support between 2015 and 2020. The most common indications for ECMO support in these patients were acute respiratory distress syndrome and sepsis. The average ECMO support hours for our population was 336 hours. Eleven out of fifteen patients were supported with VA ECMO and one patient was converted from VV to VA during the hospitalization. We observed a 66.7% survival to decannulation and 60% to discharge. Of note, 40% of our patients had a history of bone marrow transplant (BMT) and the survival to discharge in this subgroup was found to be 66.7%. In tandem CRRT therapy did not seem to have an effect on survival. The population who received both CRRT and TPE in tandem therapy had a lower rate of survival.
Conclusions: To our knowledge, this report is the largest single center cohort of pediatric hematology/oncology patients with a history of ECMO support. Our findings demonstrate a higher rate of survival to decannulation and discharge in this patient population than previously reported. In addition, a history of BMT did not increase the risk of mortality in our cohort. These findings would support the use of ECMO as a lifesaving therapy in this particular pediatric population.
MeSH Keywords
Pediatric ECMO; Hematology/Oncology; Bone Marrow Transplant
Included in
Critical Care Commons, Hematology Commons, Higher Education and Teaching Commons, Medical Education Commons, Nephrology Commons, Oncology Commons, Pediatrics Commons, Science and Mathematics Education Commons
A New Paradigm: ECMO Therapy in Pediatric Hematology/Oncology Patients
Background: The use of extracorporeal membrane oxygenation (ECMO) for support of pediatric patients has significantly increased in the past years. Patients with known oncologic diseases, immunodeficiencies, or bone marrow transplants (BMT) have traditionally not been considered candidates for Extracorporeal membrane oxygenation (ECMO) due to perceived high risk for mortality. Ongoing advances have continued to push the boundaries of ECMO use and we report our recent experience with this patient population
Objectives/Goal: To evaluate survival to discharge of pediatric patients who require ECMO support and who also have an underlying hematologic or oncologic disease process. To determine specific patient characteristics that would affect morbidity and mortality for this particular patient population. To evaluate the effects of concomitant support therapies, such as CRRT or total plasma exchange (TPE), on survival to discharge.
Methods/Design: Single center chart review cohort study involving 15 patients with a history of hematologic/oncologic diagnosis or bone marrow transplantation admitted to the PICU at Children’s Mercy Hospital between 2015 and 2020 and who required ECMO for respiratory or hemodynamic support.
Results: We identified 15 patients with ages raging between 3 weeks and 16 years of age with both hematologic and oncologic diagnoses who required ECMO support between 2015 and 2020. The most common indications for ECMO support in these patients were acute respiratory distress syndrome and sepsis. The average ECMO support hours for our population was 336 hours. Eleven out of fifteen patients were supported with VA ECMO and one patient was converted from VV to VA during the hospitalization. We observed a 66.7% survival to decannulation and 60% to discharge. Of note, 40% of our patients had a history of bone marrow transplant (BMT) and the survival to discharge in this subgroup was found to be 66.7%. In tandem CRRT therapy did not seem to have an effect on survival. The population who received both CRRT and TPE in tandem therapy had a lower rate of survival.
Conclusions: To our knowledge, this report is the largest single center cohort of pediatric hematology/oncology patients with a history of ECMO support. Our findings demonstrate a higher rate of survival to decannulation and discharge in this patient population than previously reported. In addition, a history of BMT did not increase the risk of mortality in our cohort. These findings would support the use of ECMO as a lifesaving therapy in this particular pediatric population.
Comments
Abstract Only.