Extracorporeal membrane oxygenation in children receiving haematopoietic cell transplantation and immune effector cell therapy: an international and multidisciplinary consensus statement

Abstract

Use of extracorporeal membrane oxygenation (ECMO) in children receiving hematopoietic cell transplantation (HCT) and/or Immune Effector Cells (IEC) remains controversial and evidence-based guidelines are lacking. Remarkable advancements in HCT and IEC therapies have changed expectations around reversibility of organ dysfunction and life-expectancy for affected patients. Herein, members of the Extracorporeal Life Support Organization (ELSO), Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network- (HCT and Cancer Immunotherapy Subgroup), the Pediatric Diseases Working Party of the European Society for Blood and Marrow Transplantation (EBMT), the supportive care committee of the Pediatric Transplantation and Cellular Therapy Consortium (PTCTC) and the Pediatric Intensive Care Oncology Kids in Europe Research (POKER) group of the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) provide consensus recommendations on the use of ECMO in children receiving HCT-IEC. These are the first international, multi-disciplinary consensus-based recommendations on the use of ECMO in HCT-IEC pediatric patients. This manuscript may serve as a clinical decision support tool for pediatric hematologists, oncologists, and critical care physicians during the difficult decision-making process of ECMO candidacy and management. These recommendations may represent a base for future research studies focused on ECMO selection criteria and bedside management.