Combined advances in haematopoietic cell transplantation (HCT) and intensive care
management have improved the survival of patients with haematological malignancies
admitted to the intensive care unit. In cases of refractory respiratory failure or
refractory cardiac failure, these advances have led to a renewed interest in advanced
life support therapies, such as extracorporeal membrane oxygenation (ECMO), previously
considered inappropriate for these patients due to their poor prognosis. Given the
scarcity of evidence-based guidelines on the use of ECMO in patients receiving HCT
and the need to provide equitable and sustainable access to ECMO, the European Society
of Intensive Care Medicine, the Extracorporeal Life Support Organization, and the
International ECMO Network aimed to develop an expert consensus statement on the use
of ECMO in adult patients receiving HCT.
During VV ECMO, there was no universally accepted threshold for transfusion, but PRBC
transfusion was invariably associated with lower mortality only when done with haemoglobin
concentration of less than 7 g/dL.
In our study, only a third of patients were alive without moderate-to-severe disability
at 6 months after initiation of ECMO. The finding that disability was common across
all areas of functioning points to the need for long-term, multidisciplinary care
and support for surviving patients who have had ECMO. Further studies are needed to
understand the 180-day and longer-term prognosis of patients with different diagnoses
receiving different modes of ECMO, which could have important implications for the
selection of patients for ECMO and management strategies in the ICU.
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