(1148) Effectiveness of ECMO in Critically Ill Patients With Solid Malignancies

Introduction: The role of extracorporeal membrane oxygenation (ECMO) in critically ill patients with solid malignancies is unclear. The EOLIA trial excluded such patients, and the Extracorporeal Life Support Organization lists malignancy and immunosuppression as relative contraindications for ECMO. This study aims to investigate the use and effectiveness of ECMO in patients with solid malignancies.

Methods: This retrospective cohort study at Asan Medical Center in Seoul analyzed patients with solid malignancies admitted to the medical ICU from 2016 to 2022. Data were gathered from electronic medical records. Patients were divided into two groups: those who underwent ECMO for a procedure or surgery and those who did not. The study compared the clinical characteristics and treatment outcomes between these groups.

Results: Among 955 ICU patients with solid malignancies, 26 ECMO patients were included in the study. A total of 14 patients received ECMO for the procedure or surgery, including central airway stent insertion (n=11), tracheostomy (n=1), mediastinal mass debulking surgery (n=1), and pulmonary thromboembolectomy (n=1). The causes of ECMO were significantly different in the other group, with acute respiratory distress syndrome (n=2), airway problems (n=3), cardiogenic shock (n=3), cardiac arrest (n=3) (p=0.009).
Patients with ECMO for the procedure or surgery showed higher proportion of lung cancer (57% vs. 16.7%, p=0.054), were less likely to have received chemotherapy recently (50% vs. 91.7%, p=0.036), were less likely to receive vasopressors at ICU admission (50% vs. 100%, p=0.006), and used a venovenous configuration more frequently (85.71% vs. 33.33%, p =0.014), compared to the other group. The ICU mortality in the patients with ECMO for a procedure or surgery was significantly lower (14.29% vs.58.33%, p=0.038) than the ICU mortality in the other group, and it was comparable to the ICU mortality in our overall ICU patients with solid malignancies (23.1%, p=0.434).

Conclusions: Our study found that using ECMO for procedures or surgeries in critically ill patients with solid malignancies led to significantly better ICU outcomes compared to its use in other situations. Therefore, ECMO should be actively considered as an adjunctive measure for these patients when they require a procedure or surgery.