(1187) ECMO in Pediatric Oncologic and Hematopoietic Stem Cell Transplant Patients: A Comparative Analysis

Introduction: Pediatric oncologic and hematopoietic stem cell transplant (HSCT) recipients are vulnerable to development of respiratory failure due to chemotherapy, radiation, surgery, and immunosuppression. Yet, providing extracorporeal membrane oxygenation (ECMO) support in these patient populations remains controversial with heterogenous utilization across pediatric institutions. The aim of this study is to characterize and compare outcomes in pediatric oncologic and HSCT patients with respiratory failure in the presence and absence of ECMO support.

Methods: This study was a retrospective matched comparative analysis between two tertiary care pediatric institutions. Patients less than 18 years old with an underlying oncologic diagnosis and/or HSCT with severe acute respiratory distress syndrome (ARDS) from 2015-2023 were included. Children’s Mercy Pediatric Intensive Care Unit (PICU) served as the ECMO cohort; Cincinnati Children’s PICU served as the matched non-ECMO control. Patients were identified via electronic medical records and matched via blinded multidisciplinary team based on diagnosis, age, oxygenation index (OI), and peak inspiratory pressures (PIPs).

Results: Twenty-two patients were included (n=11 ECMO; 11= Control). Median cohort ages were 4 and 5 years, respectively. Underlying diagnoses for each group included 54.5% with hematologic malignancy, 18% with solid tumor malignancy, and 27% with non-oncologic diagnosis. Each cohort had six patients with HSCTs (54.5%). Calculated OIs for each cohort were similar at 32.8 and 37.5, and PIPs were 35.5 and 37, comparatively. The ECMO cohort had 5 of 11 (45%) patients survive to hospital discharge compared to 3 of 11 (27%) non-ECMO controls (p = 0.659). Median length of mechanical ventilation was 18 vs 21 days, and length of hospital stay was 71 vs 74 days, respectively.

Conclusions: These study findings highlight that ECMO utilization in pediatric oncologic and HSCT patients with respiratory failure may not be inferior to conventional PICU management but rather a viable option during acute respiratory illness.