Filho Roberto Rabello, Joelsons Daniel, de Arruda Bravim Bruno
Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Front Med (Lausanne). 2024 Oct 22;11:1394051. doi: 10.3389/fmed.2024.1394051. eCollection 2024.
Combined progress in oncology and critical care medicine has led to new aspirations and discussions in advanced life support modalities in the intensive care unit. Over the last decade, extracorporeal membrane oxygenation, previously considered unsuitable for oncologic patients, has become increasingly popular, with more diverse applications. Nevertheless, mortality remains high in critically ill cancer patients, and eligibility for extracorporeal membrane oxygenation can be extremely challenging. This scenario is even more difficult due to the uncertain prognosis regarding the underlying malignancy, the increased rate of infections related to intensive care unit admission, and the high risk of adverse events during extracorporeal membrane oxygenation support. With advances in technology and better management involving extracorporeal membrane oxygenation, new data on clinical outcomes can be found. Therefore, this review article evaluates the indicators for extracorporeal membrane oxygenation in different types of oncology patients and the possible subgroups that could benefit from it. Furthermore, we highlight the prognosis, the risk factors for complications during this support, and the importance of decision-making based on a multidisciplinary team in the extracorporeal membrane oxygenation indication.
肿瘤学和重症医学的共同进步引发了重症监护病房高级生命支持模式方面的新期望和讨论。在过去十年中，体外膜肺氧合（ECMO），这种以前被认为不适用于肿瘤患者的技术，越来越受欢迎，应用也更加多样化。然而，重症癌症患者的死亡率仍然很高，而确定是否适合使用体外膜肺氧合可能极具挑战性。由于潜在恶性肿瘤的预后不确定、因入住重症监护病房而导致的感染率增加以及体外膜肺氧合支持期间发生不良事件的高风险，这种情况变得更加困难。随着技术的进步以及涉及体外膜肺氧合的更好管理，可以获得有关临床结果的新数据。因此，这篇综述文章评估了不同类型肿瘤患者体外膜肺氧合的指标以及可能从中受益的亚组。此外，我们强调了预后、这种支持期间并发症的风险因素以及在体外膜肺氧合适应症中基于多学科团队进行决策的重要性。
