vv-ECMO tied to poor survival in cancer patients, optimal for selected patients, study suggests
Germany: Cancer patients who require veno-venous extracorporeal membrane oxygenation (vv-ECMO) have a very poor overall survival, reveals a recent study published in the journal Intensive Care Medicine. The researchers, therefore, suggest that vv-ECMO should only be offered to selected patients. Further, the value of vv-ECMO in cancer patients with respiratory failure is shown to be still unclear and requires further research.
Matthias Kochanek and the team identified factors such as low platelet count, disease status, and high lactate levels to be indicators of poor prognosis that should be accounted for in decision making to provide vv-ECMO.
Prior to the study, there was no answer to the question of whether cancer patients with severe respiratory failure benefit from vv-ECMO. To address this Dr. Kochanek and the team analyzed clinical characteristics and outcomes of a large cohort of cancer patients treated with vv-ECMO with the aim to identify prognostic factors.
For achieving their objective, the researchers retrospectively analyzed 297 cancer patients from 19 German and Austrian hospitals who underwent vv-ECMO between 2009 and 2019. Multivariable cox proportional hazards analysis was performed for overall analysis. Also, they conducted a propensity score-matched analysis and latent class analysis.
The median age of the patients was 56 years and 214 (72%) were males. 159 (54%) had a solid tumor and 138 (47%) had a hematologic malignancy.
Key findings include:
- The 60-day overall survival rate was 26.8%.
- Low platelet count (HR 0.997), elevated lactate levels (HR 1.048), and disease status (progressive disease [HR 1.871], newly diagnosed [HR 1.571]) were independent adverse prognostic factors for overall survival.
- A propensity score-matched analysis with patients who did not receive ECMO treatment showed no significant survival advantage for treatment with ECMO.
"Findings showed that the overall survival of cancer patients requiring vv-ECMO is poor," wrote the authors. "The value of vv-ECMO in cancer patients with respiratory failure is still unclear and requires further research."
"The risk factors identified in the present analysis may help to better select patients who may benefit from vv-ECMO," they concluded.
Reference:
Kochanek, M., Kochanek, J., Böll, B. et al. Veno-venous extracorporeal membrane oxygenation (vv-ECMO) for severe respiratory failure in adult cancer patients: a retrospective multicenter analysis. Intensive Care Med (2022). https://doi.org/10.1007/s00134-022-06635-y
