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Education, Teaching, and Quality Improvement |

Clinical Outcomes of Extracorporeal Membrane Oxygenation Support for Patients With Hematologic Malignancies

Hye Seon Kang; Jeong Uk Lim; Hwa Young Lee; Hea Yon Lee; Chin Kook Rhee, PhD
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The Catholic University of Korea School of Medicine, Seoul, Republic of Korea


Chest. 2014;146(4_MeetingAbstracts):494A. doi:10.1378/chest.1992591
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Abstract

SESSION TITLE: Outcomes/Quality Control Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: This study aimed to determine the clinical outcomes of extracorporeal membrane oxygenation (ECMO) in patients with hematologic malignancies who have failed optimal conventional therapy.

METHODS: We retrospectively reviewed the medical records of all patients who required ECMO at a medical intensive care unit of Seoul St. Mary’s Hospital between February 2010 and July 2013. Fifteen patients with hematologic malignancies were compared with 33 immunocompetent patients.

RESULTS: Underlying hematologic malignancies were associated with lower overall survival (0.0% vs. 24.2%, P = 0.044). Mortality was significantly associated with a higher 24-hour ECMO inspired fraction of oxygen (0.71±0.24 vs. 0.47±0.13, P = 0.015), the development of infection after ECMO (87.5% vs. 25.0%, P = 0.001) and the presence of hepatic failure (70.0% vs. 0.0%, P < 0.001). After adjustment for APACHE II scores, the increased risk of mortality persisted for patients with hematologic malignancies (0.0% vs. 40.0%, P = 0.017). The mean difference in inotropic equivalent scores after ECMO was significantly lower in immunocompetent patients (-59.22±97.83 vs. 53.87±164.46, P = 0.026).

CONCLUSIONS: In conclusion, our study suggests that patients with hematologic disease who require ECMO for cardiopulmonary support have poor outcomes. Increased mortality was associated with the development of infection and hepatic failure during ECMO. However, the incidence of complications in patients with hematologic malignancy did not differ significantly from that in immunocompetent patients. Therefore, ECMO application in patients with hematologic disease deserves much consideration. For the evidences to support ECMO as therapy in these high-risk patients, it needs well-designed randomized controlled study.

CLINICAL IMPLICATIONS: Therefore, ECMO application in patients with hematologic disease deserves much consideration. For the evidences to support ECMO as therapy in these high-risk patients, it needs well-designed randomized controlled study.

DISCLOSURE: The following authors have nothing to disclose: Hye Seon Kang, Jeong Uk Lim, Hwa Young Lee, Hea Yon Lee, Chin Kook Rhee

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