Outcomes of extracorporeal membrane oxygenation in adults with active hematologic and non-hematologic malignancy.

BACKGROUND Although the number of cancer patients admitted to the intensive care unit is increasing, the data on the use of extracorporeal membrane oxygenation in patients with malignancy are limited. METHODS We applied extracorporeal membrane oxygenation to carefully selected patients with active hematologic malignancy or non-hematologic malignancy who experienced respiratory or cardiac failure despite maximal conventional therapy. Patients with active malignancy who underwent extracorporeal membrane oxygenation in our institution between January 2012 and December 2016 were included in this study. The primary outcome of this study was defined as survival to hospital discharge. We also investigated the factors associated with survival to hospital discharge. RESULTS There were 30 (30.6%) and 68 (69.4%) patients in the hematologic malignancy group and the non-hematologic malignancy group, respectively. Patients in the hematologic malignancy group were younger, more neutropenic, and hypotensive and had a lower Charlson comorbidity index, higher sequential organ failure assessment score, and lower platelet count than those in the non-hematologic malignancy group. Forty-six (46.9%) patients were successfully weaned off extracorporeal membrane oxygenation, and 30 (30.6%) patients survived until hospital discharge. Hospital survival rate and survival status six months after hospital discharge were significantly lower in patients with hematologic malignancy than in those with non-hematologic malignancy (13.3% vs. 38.2%, P = .026 and 3.3% vs. 26.5%, P = .017, respectively). Multivariate analysis identified an active hematologic malignancy, older age, acidosis, thrombocytopenia, high vasoactive-inotrope score, and respiratory failure as the risk factors for in-hospital death. CONCLUSIONS Patients with hematologic malignancy requiring extracorporeal membrane oxygenation support had significantly lower rates of hospital survival and six-month survival after discharge than patients with non-hematologic malignancy. Therefore, extracorporeal membrane oxygenation for treating cardiac or respiratory failure should only be considered in highly selected patients with hematologic malignancy.