TY - JOUR
T1 - Role of extracorporeal membrane oxygenation in pediatric cancer patients
T2 - a systematic review and meta-analysis of observational studies
AU - Slooff, Valerie
AU - Hoogendoorn, Rianne
AU - Nielsen, Jeppe Sylvest Angaard
AU - Pappachan, John
AU - Amigoni, Angela
AU - Caramelli, Fabio
AU - Aziz, Omer
AU - Wildschut, Enno
AU - Verbruggen, Sascha
AU - Crazzolara, Roman
AU - Dohna-Schwake, Christian
AU - Potratz, Jenny
AU - Willems, Jef
AU - Llevadias, Judit
AU - Moscatelli, Andrea
AU - Montaguti, Alessia
AU - Bottari, Gabriella
AU - Di Nardo, Matteo
AU - Schlapbach, Luregn
AU - Wösten-van Asperen, Roelie
AU - the POKER (PICU Oncology Kids in Europe Research group) research consortium of ESPNIC (European Society of Paediatric Neonatal Intensive Care)
N1 - Publisher Copyright:
© 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - Background: The use of extracorporeal membrane oxygenation (ECMO) in pediatric patients with underlying malignancies remains controversial. However, in an era in which the survival rates for children with malignancies have increased significantly and several recent reports have demonstrated effective ECMO use in children with cancer, we aimed to estimate the outcome and complications of ECMO treatment in these children. Methods: We searched MEDLINE, Embase and CINAHL databases for studies on the use ECMO in pediatric patients with an underlying malignancy from inception to September 2020. This review was conducted in adherence to Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Study eligibility was independently assessed by two authors and disagreements resolved by a third author. Included studies were evaluated for quality using the Newcastle–Ottawa Scale (NOS). Random effects meta-analyses (DerSimonian and Laird) were performed. The primary outcomes were mortality during ECMO or hospital mortality. Results: Thirteen retrospective, observational cohort studies were included, most of moderate quality (625 patients). The commonest indication for ECMO was severe respiratory failure (92%). Pooled mortality during ECMO was 55% (95% confidence interval [CI], 47–63%) and pooled hospital mortality was 60% (95% CI 54–67%). Although heterogeneity among the included studies was low, confidence intervals were large. In addition, the majority of the data were derived from registries with overlapping patients which were excluded for the meta-analyses to prevent resampling of the same participants across the included studies. Finally, there was a lack of consistent complications reporting among the studies. Conclusion: Significantly higher mortalities than in general PICU patients was reported with the use of ECMO in children with malignancies. Although these results need to be interpreted with caution due to the lack of granular data, they suggest that ECMO appears to represents a viable rescue option for selected patients with underlying malignancies. There is an urgent need for additional data to define patients for whom ECMO may provide benefit or harm.
AB - Background: The use of extracorporeal membrane oxygenation (ECMO) in pediatric patients with underlying malignancies remains controversial. However, in an era in which the survival rates for children with malignancies have increased significantly and several recent reports have demonstrated effective ECMO use in children with cancer, we aimed to estimate the outcome and complications of ECMO treatment in these children. Methods: We searched MEDLINE, Embase and CINAHL databases for studies on the use ECMO in pediatric patients with an underlying malignancy from inception to September 2020. This review was conducted in adherence to Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Study eligibility was independently assessed by two authors and disagreements resolved by a third author. Included studies were evaluated for quality using the Newcastle–Ottawa Scale (NOS). Random effects meta-analyses (DerSimonian and Laird) were performed. The primary outcomes were mortality during ECMO or hospital mortality. Results: Thirteen retrospective, observational cohort studies were included, most of moderate quality (625 patients). The commonest indication for ECMO was severe respiratory failure (92%). Pooled mortality during ECMO was 55% (95% confidence interval [CI], 47–63%) and pooled hospital mortality was 60% (95% CI 54–67%). Although heterogeneity among the included studies was low, confidence intervals were large. In addition, the majority of the data were derived from registries with overlapping patients which were excluded for the meta-analyses to prevent resampling of the same participants across the included studies. Finally, there was a lack of consistent complications reporting among the studies. Conclusion: Significantly higher mortalities than in general PICU patients was reported with the use of ECMO in children with malignancies. Although these results need to be interpreted with caution due to the lack of granular data, they suggest that ECMO appears to represents a viable rescue option for selected patients with underlying malignancies. There is an urgent need for additional data to define patients for whom ECMO may provide benefit or harm.
KW - Cancer
KW - Extracorporeal membrane oxygenation
KW - Meta-analysis
KW - Outcomes
KW - Pediatric intensive care unit
KW - Systematic review
UR - http://www.scopus.com/inward/record.url?scp=85124841675&partnerID=8YFLogxK
U2 - 10.1186/s13613-022-00983-0
DO - 10.1186/s13613-022-00983-0
M3 - Review
C2 - 35092500
AN - SCOPUS:85124841675
SN - 2110-5820
VL - 12
JO - Annals of Intensive Care
JF - Annals of Intensive Care
IS - 1
M1 - 8
ER -