TY - JOUR
T1 - The Feasibility of Venovenous Extracorporeal Life Support to Treat Acute Respiratory Failure in Adult Cancer Patients
AU - Wu, Meng Yu
AU - Wu, Tzu I.
AU - Tseng, Yuan His
AU - Shen, Wen Chi
AU - Chang, Yu Sheng
AU - Huang, Chung Chi
AU - Lin, Pyng Jing
N1 - Publisher Copyright:
© 2015 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2015/5/5
Y1 - 2015/5/5
N2 - Venovenous extracorporeal life support (VV-ECLS) is a lifesaving but invasive treatment for acute respiratory failure (ARF) that is not improved with conventional therapy. However, using VV-ECLS to treat ARF in adult cancer patients is controversial. This retrospective study included 14 cancer patients (median age: 58 years [interquartile range: 51-66]; solid malignancies in 13 patients and hematological malignancy in 1 patient) who received VV-ECLS for ARF that developed within 3 months after anticancer therapies. VV-ECLS would be considered in selected patients with a P aO2/Fi O2 ratio ≤70mmHg under advanced mechanical ventilation. Before ECLS, the medians of intubation day, P aO2/Fi O2 ratio, and Sequential Organ Failure Assessment (SOFA) score were 8 (2-12), 62mmHg (53-76), and 10 (9-14), respectively. The case numbers of bacteremia, thrombocytopenia (platelet count <50000cells/μL), and neutropenia (actual neutrophil count <1000cells/μL) detected before ECLS were 3 (21%), 2 (14%), and 1 (7%), respectively. After 24hours of ECLS, a significant improvement was seen in P aO2/Fi O2 ratio but not in SOFA score. Six patients experienced major hemorrhages during ECLS. The median ECLS day, ECLS weaning rate, and hospital survival were 11 (7-16), 50% (n=7), and 29% (n=4). The development of dialysis-dependent nephropathy predicted death on ECLS (odds ratio: 36; 95% confidence interval: 1.8-718.7; P=0.01). With a median follow-up of 11 (6-43) months, half of the survivors died of cancer recurrence and the others were in partial remission. The most prominent benefit of VV-ECLS is to improve the arterial oxygenation and rest the lungs. This may increase the chance of recovery from ARF in selected cancer patients.
AB - Venovenous extracorporeal life support (VV-ECLS) is a lifesaving but invasive treatment for acute respiratory failure (ARF) that is not improved with conventional therapy. However, using VV-ECLS to treat ARF in adult cancer patients is controversial. This retrospective study included 14 cancer patients (median age: 58 years [interquartile range: 51-66]; solid malignancies in 13 patients and hematological malignancy in 1 patient) who received VV-ECLS for ARF that developed within 3 months after anticancer therapies. VV-ECLS would be considered in selected patients with a P aO2/Fi O2 ratio ≤70mmHg under advanced mechanical ventilation. Before ECLS, the medians of intubation day, P aO2/Fi O2 ratio, and Sequential Organ Failure Assessment (SOFA) score were 8 (2-12), 62mmHg (53-76), and 10 (9-14), respectively. The case numbers of bacteremia, thrombocytopenia (platelet count <50000cells/μL), and neutropenia (actual neutrophil count <1000cells/μL) detected before ECLS were 3 (21%), 2 (14%), and 1 (7%), respectively. After 24hours of ECLS, a significant improvement was seen in P aO2/Fi O2 ratio but not in SOFA score. Six patients experienced major hemorrhages during ECLS. The median ECLS day, ECLS weaning rate, and hospital survival were 11 (7-16), 50% (n=7), and 29% (n=4). The development of dialysis-dependent nephropathy predicted death on ECLS (odds ratio: 36; 95% confidence interval: 1.8-718.7; P=0.01). With a median follow-up of 11 (6-43) months, half of the survivors died of cancer recurrence and the others were in partial remission. The most prominent benefit of VV-ECLS is to improve the arterial oxygenation and rest the lungs. This may increase the chance of recovery from ARF in selected cancer patients.
UR - http://www.scopus.com/inward/record.url?scp=84938857212&partnerID=8YFLogxK
U2 - 10.1097/MD.0000000000000893
DO - 10.1097/MD.0000000000000893
M3 - 文章
C2 - 26020399
AN - SCOPUS:84938857212
SN - 0025-7974
VL - 94
JO - Medicine (United States)
JF - Medicine (United States)
IS - 21
M1 - e893
ER -
