Clinical Investigations

Extracorporeal life support for support of children with malignancy and respiratory or cardiac failure: The extracorporeal life support experience*

Gow, Kenneth W. MD, FACS, FAAP; Heiss, Kurt F. MD, FACS, FAAP; Wulkan, Mark L. MD, FACS, FAAP; Katzenstein, Howard M. MD; Rosenberg, Eli S. BS; Heard, Michael L. RN; Rycus, Peter T. MPH; Fortenberry, James D. MD, FCCM, FAAP

Author Information

From the Department of Surgery (KWG, KFH, MLW), Division of Pediatric Surgery, Emory University, Atlanta, GA; Department of Hematology/Oncology/BMT (HMK), Aflac Cancer Center, Atlanta, GA; Department of Biostatistics (ESR), Emory University, Atlanta, GA; Department of Pediatrics (MLH, JDF), Emory University School of Medicine, and Center for ECMO and Advanced Technologies, Children’s Healthcare of Atlanta at Egleston, Atlanta, GA; and Extracorporeal Life Support Organization (ELSO) (PR), University of Michigan, Ann Arbor, MI.

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: [email protected]

Critical Care Medicine 37(4):p 1308-1316, April 2009. | DOI: 10.1097/CCM.0b013e31819cf01a

Abstract

Background:

Extracorporeal life support (ECLS) is a means of respiratory and hemodynamic support for patients failing conventional therapies. Children with cancer who develop complications during therapy may require ECLS.

Methods:

The extracorporeal life support organization (ELSO) registry was queried for all patients younger than 21 years with an International Classification of Diseases, Ninth Revision diagnosis of neoplasm. ELSO centers were also asked whether patients with neoplasms should be offered ECLS.

Results:

From 1994 to 2007, 107 children met inclusion criteria: 73 with hematologic malignancies and 34 with solid tumors. The median age was 3.71 years. Patients had a total of 112 ECLS runs (five patients had two runs). Patients required ECLS primarily for pulmonary support (n = 86). Median duration of ECLS was 6.1 days. Overall, 62 of 107 patients (58%) died while on ECLS because of irreversible organ failure (n = 37), diagnosis incompatible with life (n = 11), hemorrhage (n = 6), and family request (n = 8). Forty-five of 107 patients (42%) survived ECLS. During the remaining hospitalization, eight patients died resulting in 37 of 107 surviving to hospital discharge (35%). Risk factors for death included lower Po₂ before ECLS, higher oxygen index, higher positive end-expiratory pressure, and development of renal or cardiopulmonary complications (p < 0.05). No differences in outcomes were noted in patients with either hematologic malignancies or solid tumors. One hundred eighteen of 133 eligible ECLS centers responded to the questionnaire for an 89% response rate. Among those who responded, 112 of 133 would consider placing a child (95%) with a neoplasm on ECLS.

Conclusion:

Children with cancer and respiratory failure can be offered ECLS with a reasonable expectation for survival. The opinions of the ELSO center suggest that decisions to offer ECLS to a child with malignancy should be made on a case by case basis, with prognosis of the malignancy being an important factor.