Taylor L Olson1, Erika R O'Neil, Kristen J Kurtz, Graeme MacLaren, Marc M Anders. 1. 1 Department of Pediatrics, Baylor College of Medicine, Houston, TX. 2 Baylor College of Medicine, Texas Children's Hospital, Houston, TX. 3 Cardiothoracic Intensive Care Unit, National University Hospital, Singapore. 4 Paediatric Intensive Care Unit, Royal Children's Hospital, Melbourne, VIC, Australia. 5 Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX.
Abstract
OBJECTIVES: The objective of this study was to provide an updated review of survival for pediatric hematopoietic stem cell transplantation patients requiring extracorporeal membrane oxygenation therapy as well as characterize the demographics, clinical variables, and complications associated with mortality. DESIGN: Retrospective database review of the Extracorporeal Life Support Organization Registry from 1990 to 2019. SETTING: Extracorporeal membrane oxygenation centers reporting to Extracorporeal Life Support Organization. PATIENTS: Patients treated with extracorporeal membrane oxygenation greater than 28 days to 18 years old with International Classification of Diseases Ninth Revision, International Classification of Diseases Tenth Revision, and current procedural terminology codes consistent with hematopoietic stem cell transplantation were included. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Demographics, year of extracorporeal membrane oxygenation run, clinical variables, comorbid diagnoses, and extracorporeal membrane oxygenation complications were assessed in relation to the primary study outcome of survival to hospital discharge. Ninety patients were included in the final analysis. The overall survival rate for the study period was 19%. However, the survival rate in the last decade (2010-2019) improved to 26% (p = 0.01; odds ratio 9.4 [1.2-74.8]). Factors associated with decreased survival included comorbid malignancy, elevated peak inspiratory pressure in conventionally ventilated patients, and pulmonary and metabolic complications on extracorporeal membrane oxygenation. CONCLUSIONS: Pediatric patients posthematopoietic stem cell transplantation supported with extracorporeal membrane oxygenation have improving survival rates over time. With 26% of patients (16/62) surviving to hospital discharge in the last decade (2010-2019), history of hematopoietic stem cell transplantation may no longer be considered an absolute contraindication to extracorporeal membrane oxygenation. As advancements are made in hematopoietic stem cell transplantation therapies and extracorporeal membrane oxygenation management, the indications for life-saving extracorporeal membrane oxygenation support among patients posthematopoietic stem cell transplantation may expand accordingly.
OBJECTIVES: The objective of this study was to provide an updated review of survival for pediatric hematopoietic stem cell transplantation patients requiring extracorporeal membrane oxygenation therapy as well as characterize the demographics, clinical variables, and complications associated with mortality. DESIGN: Retrospective database review of the Extracorporeal Life Support Organization Registry from 1990 to 2019. SETTING: Extracorporeal membrane oxygenation centers reporting to Extracorporeal Life Support Organization. PATIENTS: Patients treated with extracorporeal membrane oxygenation greater than 28 days to 18 years old with International Classification of Diseases Ninth Revision, International Classification of Diseases Tenth Revision, and current procedural terminology codes consistent with hematopoietic stem cell transplantation were included. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Demographics, year of extracorporeal membrane oxygenation run, clinical variables, comorbid diagnoses, and extracorporeal membrane oxygenation complications were assessed in relation to the primary study outcome of survival to hospital discharge. Ninety patients were included in the final analysis. The overall survival rate for the study period was 19%. However, the survival rate in the last decade (2010-2019) improved to 26% (p = 0.01; odds ratio 9.4 [1.2-74.8]). Factors associated with decreased survival included comorbid malignancy, elevated peak inspiratory pressure in conventionally ventilated patients, and pulmonary and metabolic complications on extracorporeal membrane oxygenation. CONCLUSIONS: Pediatric patients posthematopoietic stem cell transplantation supported with extracorporeal membrane oxygenation have improving survival rates over time. With 26% of patients (16/62) surviving to hospital discharge in the last decade (2010-2019), history of hematopoietic stem cell transplantation may no longer be considered an absolute contraindication to extracorporeal membrane oxygenation. As advancements are made in hematopoietic stem cell transplantation therapies and extracorporeal membrane oxygenation management, the indications for life-saving extracorporeal membrane oxygenation support among patients posthematopoietic stem cell transplantation may expand accordingly.
Authors: Matteo Di Nardo; Ali H Ahmad; Pietro Merli; Matthew S Zinter; Leslie E Lehman; Courtney M Rowan; Marie E Steiner; Sangeeta Hingorani; Joseph R Angelo; Hisham Abdel-Azim; Sajad J Khazal; Basirat Shoberu; Jennifer McArthur; Rajinder Bajwa; Saad Ghafoor; Samir H Shah; Hitesh Sandhu; Karen Moody; Brandon D Brown; Maria E Mireles; Diana Steppan; Taylor Olson; Lakshmi Raman; Brian Bridges; Christine N Duncan; Sung Won Choi; Rita Swinford; Matt Paden; James D Fortenberry; Giles Peek; Pierre Tissieres; Daniele De Luca; Franco Locatelli; Selim Corbacioglu; Martin Kneyber; Alessio Franceschini; Simon Nadel; Matthias Kumpf; Alessandra Loreti; Roelie Wösten-Van Asperen; Orsola Gawronski; Joe Brierley; Graeme MacLaren; Kris M Mahadeo Journal: Lancet Child Adolesc Health Date: 2021-12-09
Authors: Jenny C Potratz; Sarah Guddorf; Martina Ahlmann; Maria Tekaat; Claudia Rossig; Heymut Omran; Katja Masjosthusmann; Andreas H Groll Journal: Front Oncol Date: 2021-04-27 Impact factor: 6.244
Authors: Matt S Zinter; Jennifer McArthur; Christine Duncan; Roberta Adams; Erin Kreml; Heidi Dalton; Hisham Abdel-Azim; Courtney M Rowan; Shira J Gertz; Kris M Mahadeo; Adrienne G Randolph; Prakadeshwari Rajapreyar; Marie E Steiner; Leslie Lehmann Journal: Pediatr Crit Care Med Date: 2022-03-01 Impact factor: 3.624