Veno-venous extracorporeal membrane oxygenation (vv-ECMO) for severe respiratory failure in adult cancer patients: a retrospective multicenter analysis.
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Kochanek Matthias, Kochanek Jan, Böll Boris, Eichenauer Dennis A, Beutel Gernot, Bracht Hendrik, Braune Stephan, Eisner Florian, Friesecke Sigrun, Günther Ulf, Heinz Gottfried, Hallek Michael, Karagiannidis Christian, Kluge Stefan, Kogelmann Klaus, Lebiedz Pia, Lepper Philipp M, Liebregts Tobias, Lueck Catherina, Muellenbach Ralf M, Hansen Matthias, Putensen Christian, Schellongowski Peter, Schewe Jens-Christian, Schumann-Stoiber Kathrin, Seiler Frederik, Spieth Peter, Weber-Carstens Steffen, Brodie Daniel, Azoulay Elie, Shimabukuro-Vornhagen Alexander
Аннотация
METHODS: 297 cancer patients from 19 German and Austrian hospitals who underwent vv-ECMO between 2009 and 2019 were retrospectively analyzed. A multivariable cox proportional hazards analysis for overall survival was performed. In addition, a propensity score-matched analysis and a latent class analysis were conducted.
RESULTS: Patients had a median age of 56 (IQR 44-65) years and 214 (72%) were males. 159 (54%) had a solid tumor and 138 (47%) a hematologic malignancy. The 60-day overall survival rate was 26.8% (95% CI 22.1-32.4%). Low platelet count (HR 0.997, 95% CI 0.996-0.999; p = 0.0001 per 1000 platelets/µl), elevated lactate levels (HR 1.048, 95% CI 1.012-1.084; p = 0.0077), and disease status (progressive disease [HR 1.871, 95% CI 1.081-3.238; p = 0.0253], newly diagnosed [HR 1.571, 95% CI 1.044-2.364; p = 0.0304]) were independent adverse prognostic factors for overall survival. A propensity score-matched analysis with patients who did not receive ECMO treatment showed no significant survival advantage for treatment with ECMO.
CONCLUSION: The overall survival of cancer patients who require vv-ECMO is poor. This study shows that the value of vv-ECMO in cancer patients with respiratory failure is still unclear and further research is needed. The risk factors identified in the present analysis may help to better select patients who may benefit from vv-ECMO.