(1178) Venovenous ECMO for a Patient With Acute Myeloid Leukemia Post-Induction Chemotherapy Complications

Introduction: A hematologic malignancy patient receiving post-induction chemotherapy encounters multiple complications. Indication for ECMO is controversial because prognosis is difficult to predict especially when a patient has hemorrhagic complications. Hereby, we report a case of a patient with acute myeloid leukemia complicated with multiple hemorrhage who was successfully treated with ECMO.

Description: A 39-year-old man who was admitted to ICU because of multiple complications with ARDS, pancytopenia, and multiple hematomas 3 days after induction chemotherapy. A CT scan revealed multiple intracranial bleeding without midline shift, left iliopsoas hematoma, and severe bilateral pulmonary infiltrates which was compatible with ARDS. WBC count decreased from 300 to 2.9 x 109 /L and platelet counts were 7.0 x 109 /L with coagulation disturbances. He was alert despite of intracranial hemorrhage. Hypoxemia was aggravating after initiation invasive mechanical ventilation and P/F ratio was 80 and static respiratory system compliance was 13. VV-ECMO without anticoagulation was initiated, because his hematological prognosis was expected good according to leukemic gene phenotype and the cause of ARDS was assumingly treatable. The most likely cause was assumed as tumor lysis pneumopathy, because respiratory distress was developed along with tumor lysis syndrome coinciding with profound leucocyte reduction, and in which pulmonary inflammation might subside with alleviation of tumor lysis and systemic inflammation. We started corticosteroid and broad-spectrum antibiotics, investigating infectious organisms with bronchoalveolar lavages. After 3 day of ECMO with prone positioning, his respiratory function was gradually recovered despite of pancytopenia. He was liberated from ECMO and mechanical ventilation on day 4 and 9, respectively without any significant complications.

Discussion: ECMO management of patients with hemorrhagic complications and pancytopenia has great difficulties because bleeding and infectious complications can be inevitable. Sequential massive transfusions can induce microthrombus in ECMO circuit, which may aggravate coagulopathy. However, short-term non-heparin management of ECMO was accomplished owing to high ECMO blood flow and lung rest respiratory management with prone positioning.