Abstract
Background
The use of extracorporeal membrane oxygenation (ECMO) in pediatric patients with underlying malignancies remains controversial. However, in an era in which the survival rates for children with malignancies have increased significantly and several recent reports have demonstrated effective ECMO use in children with cancer, we aimed to estimate the outcome and complications of ECMO treatment in these children.
Methods
We searched MEDLINE, Embase and CINAHL databases for studies on the use ECMO in pediatric patients with an underlying malignancy from inception to September 2020. This review was conducted in adherence to Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Study eligibility was independently assessed by two authors and disagreements resolved by a third author. Included studies were evaluated for quality using the Newcastle–Ottawa Scale (NOS). Random effects meta-analyses (DerSimonian and Laird) were performed. The primary outcomes were mortality during ECMO or hospital mortality.
Results
Thirteen retrospective, observational cohort studies were included, most of moderate quality (625 patients). The commonest indication for ECMO was severe respiratory failure (92%). Pooled mortality during ECMO was 55% (95% confidence interval [CI], 47–63%) and pooled hospital mortality was 60% (95% CI 54–67%). Although heterogeneity among the included studies was low, confidence intervals were large. In addition, the majority of the data were derived from registries with overlapping patients which were excluded for the meta-analyses to prevent resampling of the same participants across the included studies. Finally, there was a lack of consistent complications reporting among the studies.
Conclusion
Significantly higher mortalities than in general PICU patients was reported with the use of ECMO in children with malignancies. Although these results need to be interpreted with caution due to the lack of granular data, they suggest that ECMO appears to represents a viable rescue option for selected patients with underlying malignancies. There is an urgent need for additional data to define patients for whom ECMO may provide benefit or harm.
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Details
1 University Medical Centre Utrecht/Wilhelmina Children’s Hospital, Department of Pediatric Intensive Care, Utrecht, The Netherlands (GRID:grid.7692.a) (ISNI:0000000090126352)
2 Rigshospitalet, Department of Neonatology and Pediatric Intensive Care, Copenhagen, Denmark (GRID:grid.475435.4)
3 University Hospital Southampton, Pediatric Intensive Care Unit, Southampton, UK (GRID:grid.123047.3) (ISNI:0000000103590315)
4 Padua University Hospital, Pediatric Intensive Care Unit, Department of Woman’s and Child’s Health, Padua, Italy (GRID:grid.411474.3) (ISNI:0000 0004 1760 2630)
5 University-Hospital S. Orsola-Malpighi Policlinic, Department of Woman, Child and Urological Diseases, Pediatric Intensive Care Unit, Bologna, Italy (GRID:grid.412311.4)
6 Royal Bristol Children’s Hospital, Department of Pediatric Intensive Care, Bristol, UK (GRID:grid.415172.4) (ISNI:0000 0004 0399 4960)
7 Sophia Children’s Hospital, Intensive Care, Department of Pediatrics and Pediatric Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands (GRID:grid.416135.4) (ISNI:0000 0004 0649 0805)
8 Medical University of Innsbruck, Department of Pediatrics, Pediatric Intensive Care Unit, Innsbruck, Austria (GRID:grid.5361.1) (ISNI:0000 0000 8853 2677)
9 Universitätsklinik Essen, Department of Pediatric Intensive Care, Essen, Germany (GRID:grid.410718.b) (ISNI:0000 0001 0262 7331)
10 University Children’s Hospital Münster, Department of General Pediatrics-Intensive Care Medicine, Munster, Germany (GRID:grid.16149.3b) (ISNI:0000 0004 0551 4246)
11 Ghent University Hospital, Department of Pediatric Intensive Care, Ghent, Belgium (GRID:grid.410566.0) (ISNI:0000 0004 0626 3303)
12 Newcastle Upon Tyne Hospitals NHS Foundation Trust, Department of Pediatric Intensive Care, Newcastle upon Tyne, UK (GRID:grid.420004.2) (ISNI:0000 0004 0444 2244)
13 Gaslini Hospital, Department of Pediatric Intensive Care, Genova, Italy (GRID:grid.420004.2)
14 Ospedale Pediatrico Bambino Gesù, IRCC, Pediatric Intensive Care Unit, Rome, Italy (GRID:grid.414125.7) (ISNI:0000 0001 0727 6809)
15 University Children’s Hospital Zurich and University of Zurich, Pediatric and Neonatal Intensive Care Unit, Children’s Research Centre, Zurich, Switzerland (GRID:grid.412341.1) (ISNI:0000 0001 0726 4330)