ECMO Use in Pediatric Oncology and Hematopoietic Stem Cell Transplant Patients: A Descriptive and Comparative Analysis

BACKGROUND: Pediatric oncologic and hematopoietic stem cell transplant (HSCT) recipients are vulnerable to life-threatening illnesses. Extracorporeal membrane oxygenation (ECMO) support as a rescue modality in this population remains controversial. The aim of this study is to describe a large single-center experience with complications and outcomes for pediatric patients with an oncologic diagnosis and/or HSCT on ECMO, and to compare survival outcomes in a smaller multicenter cohort. PROCEDURE: This was a descriptive and comparative observational study. The descriptive analysis, a large single-center experience, examined bleeding complications, infectious rates, and survival outcomes in patients under 18 years old with an underlying oncologic diagnosis and/or HSCT on ECMO. In a small multicenter cohort, the comparative analysis evaluated survival outcomes with respiratory failure in the presence and absence of ECMO. Children's Mercy Kansas City served as the ECMO cohort; Cincinnati Children's Hospital Medical Center served as the matched non-ECMO cohort. RESULTS: Twenty-two ECMO patients were included for the descriptive analysis. Most patients had severe thrombocytopenia, with half developing bleeding complications. Nearly half of patients were neutropenic, and the majority were lymphopenic at ECMO cannulation, with only one neutropenic patient developing a new infection. Twenty-two patients were included (n = 11 ECMO; n = 11 non-ECMO) for the comparative analysis. Calculated oxygenation indices for each cohort were 32.8 and 37.5, and peak inspiratory pressures were 35.5 and 37. The ECMO cohort had 45% of patients survive to hospital discharge compared to 27% of non-ECMO controls (p = 0.659). CONCLUSIONS: The findings of this study suggest that bleeding complications and incidence of infections on ECMO are comparable to the general ECMO population. ECMO utilization in pediatric oncologic and HSCT patients with respiratory failure did not offer a survival advantage to conventional PICU management in the setting of a respiratory illness. CLINICAL TRIALS REGISTRATION NUMBER: NCT07712835.