An Hong Yul, Kang Hyoung Jin, Park June Dong
Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Acute Crit Care. 2024 Feb;39(1):108-116. doi: 10.4266/acc.2023.01088. Epub 2024 Jan 24.
In this study, we reviewed the outcomes of pediatric patients with malignancies who underwent hematopoietic stem cell transplantation (HSCT) and extracorporeal membrane oxygenation (ECMO).
We retrospectively analyzed the records of pediatric hemato-oncology patients treated with chemotherapy or HSCT and who received ECMO in the pediatric intensive care unit (PICU) at Seoul National University Children's Hospital from January 2012 to December 2020.
Over a 9-year period, 21 patients (14 males and 7 females) received ECMO at a single pediatric institute; 10 patients (48%) received veno-arterial (VA) ECMO for septic shock (n=5), acute respiratory distress syndrome (ARDS) (n=3), stress-induced myopathy (n=1), or hepatopulmonary syndrome (n=1); and 11 patients (52%) received veno-venous (VV) ECMO for ARDS due to pneumocystis pneumonia (n=1), air leak (n=3), influenza (n=1), pulmonary hemorrhage (n=1), or unknown etiology (n=5). All patients received chemotherapy; 9 received anthracycline drugs and 14 (67%) underwent HSCT. Thirteen patients (62%) were diagnosed with malignancies and 8 (38%) were diagnosed with non-malignant disease. Among the 21 patients, 6 (29%) survived ECMO in the PICU and 5 (24%) survived to hospital discharge. Among patients treated for septic shock, 3 of 5 patients (60%) who underwent ECMO and 5 of 10 patients (50%) who underwent VA ECMO survived. However, all the patients who underwent VA ECMO or VV ECMO for ARDS died.
ECMO is a feasible treatment option for respiratory or heart failure in pediatric patients receiving chemotherapy or undergoing HSCT.
在本研究中，我们回顾了接受造血干细胞移植（HSCT）和体外膜肺氧合（ECMO）的小儿恶性肿瘤患者的治疗结果。
我们回顾性分析了2012年1月至2020年12月在首尔国立大学儿童医院儿科重症监护病房（PICU）接受化疗或HSCT并接受ECMO治疗的小儿血液肿瘤患者的记录。
在9年期间，21例患者（14例男性和7例女性）在一家儿科机构接受了ECMO治疗；10例患者（48%）因感染性休克（n = 5）、急性呼吸窘迫综合征（ARDS）（n = 3）、应激性肌病（n = 1）或肝肺综合征（n = 1）接受了静脉-动脉（VA）ECMO治疗；11例患者（52%）因肺孢子菌肺炎（n = 1）、空气泄漏（n = 3）、流感（n = 1）、肺出血（n = 1）或病因不明（n = 5）导致的ARDS接受了静脉-静脉（VV）ECMO治疗。所有患者均接受了化疗；9例接受了蒽环类药物治疗，14例（67%）接受了HSCT。13例患者（62%）被诊断为恶性肿瘤，8例（38%）被诊断为非恶性疾病。在这21例患者中，6例（29%）在PICU中ECMO治疗后存活，5例（24%）存活至出院。在接受感染性休克治疗的患者中，接受ECMO治疗的5例患者中有3例（60%）存活，接受VA ECMO治疗的10例患者中有5例（50%）存活。然而，所有因ARDS接受VA ECMO或VV ECMO治疗的患者均死亡。
ECMO是接受化疗或进行HSCT的小儿患者呼吸或心力衰竭的一种可行治疗选择。
