Veno-Venous Extracorporeal Membrane Oxygenation for Children With Cancer or Hematopoietic Cell Transplant: A Ten Center Cohort

Abstract

We performed a multi-center retrospective cohort study of children aged 14 days to 18 years in the United States from 2011 to 2016 with cancer or hematopoietic cell transplant (HCT) who were supported with veno-venous extracorporeal membrane oxygenation (V-V ECMO). We compared the outcomes of children with oncological diagnoses or HCT supported with V-V ECMO to other children who have received V-V ECMO support. In this cohort of 204 patients supported with V-V ECMO, 30 (15%) had a diagnosis of cancer or a history of HCT. There were 21 patients who had oncological diagnoses without HCT and 9 children were post-HCT. The oncology/HCT group had a higher overall ICU mortality (67% vs. 28%, p<0.001), mortality on ECMO (43% vs 21%, p<0.01), and ICU mortality among ECMO survivors (35% vs 8%, p<0.01). The oncology/HCT group had a higher rate of conversion to veno-arterial (V-A) ECMO (23% vs. 9%, p=0.02) (RR 2.5, 95% CI 1.1–5.6). Children with cancer or HCT were older (6.6 years vs 2.9 years, p=0.02) and had higher creatinine levels (0.65 mg/dL vs 0.4 mg/dL, p=0.04) but were similar to the rest of the cohort for other pre-ECMO variables. For post-HCT patients, survival was significantly worse for those whose indication for HCT was cancer or immunodeficiency (0/6) as compared to other nonmalignant indications (3/3) (p=0.01).