Patients with hematologic malignancies have many reasons to die during extracorporeal membrane oxygenation

Schmidt, Matthieu; Brodie, Daniel; Combes, Alain

We read with great interest the article by Wohlfarth and colleagues
regarding the use of extracorporeal membrane oxygenation (ECMO) in 14 adult patients with hematological malignancies. We would like to highlight two main points. First, the authors focused their report and their discussion on bleeding complications and anticoagulation management in this high-risk population. Although we concede that it is a serious concern in these patients, it is not the only one. ECMO support is associated with nosocomial infections. Impairment of cellular immunity, cytopenia and chemotherapy (CT) may further increase the risks of infection and may dissuade clinicians from using ECMO in these patients. Developing new strategies that aim to limit nosocomial infections is crucial to improving outcomes in this population. ECMO in awake, non-intubated, spontaneously breathing patients with acute respiratory distress syndrome, to avoid mechanical ventilation and its related adverse events, is a potentially promising application. Thus, in our opinion, it would also be important to provide a thorough description of nosocomial infections that might have occurred in these 14 patients. Second, the authors reported that 5 of 14 patients initially received CT while receiving ECMO. The pharmacokinetics of many of the medications administered to patients receiving ECMO are complex and, to date, there are very limited data to guide our daily practice. Therefore, clinicians must be aware that providing CT to patients receiving ECMO is a potential gamble, which risks worsening patient outcomes due to ineffective drug regimens. CT during ECMO should be restricted to those cases where postponing therapy is not an option.


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September 24, 2014