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    The Lancet. Respiratory medicine. 2023 Mar 13. doi: 10.1016/S2213-2600(22)00535-5. pii: S2213-2600(22)00535-5
    Extracorporeal membrane oxygenation in adults receiving haematopoietic cell transplantation: an international expert statement.
    Di Nardo M1,  MacLaren G2,  Schellongowski P3,  Azoulay E4,  DeZern AE5,  Gutierrez C6,  Antonelli M7,  Antonini MV8,  Beutel G9,  Combes A10,  Diaz R11,  Fawzy Hassan I12,  Fowles JA13,  Jeong IS14,  Kochanek M15,  Liebregts T16,  Lueck C17,  Moody K18,  Moore JA19,  Munshi L20,  Paden M21,  Pène F22,  Puxty K23,  Schmidt M24,  Staudacher D25,  Staudinger T26,  Stemmler J27,  Stephens RS28,  Vande Vusse L29,  Wohlfarth P30,  Lorusso R31,  Amodeo A32,  Mahadeo KM33,  Brodie D34
    Author information
    1Paediatric Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy. Electronic address: matteo.dinardo@opbg.net.
    2Cardiothoracic Intensive Care Unit, National University Health System, Singapore.
    3Intensive Care Unit 13i2, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
    4Médecine Intensive et Réanimation, APHP, Saint-Louis Hospital, University of Paris, Paris, France.
    5Division of Hematologic Malignancies, Sidney Kimmel Cancer Center at Johns Hopkins, Baltimore, MD, USA.
    6Department of Critical Care Medicine, Division of Anesthesiology, Critical Care and Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
    7Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy; Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy.
    8Anaesthesia and Intensive Care Unit, Bufalini Hospital, AUSL della Romagna, Cesena, Italy; Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy.
    9Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany.
    10Institute of Cardiometabolism and Nutrition, INSERM, UMRS_1166-ICAN, Sorbonne Université, Paris, France; Service de médecine intensive-réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, Paris, France.
    11Clinica Las Condes, Santiago, Chile.
    12Corporate Critical Care Centre, Hamad Medical Corporation, Doha, Qatar.
    13Division of Surgery, Transplant and Anaesthetics, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK.
    14Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea.
    15Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center of Integrated Oncology, Aachen-Bonn-Cologne-Dusseldorf, University of Cologne, University Hospital Cologne, Cologne, Germany.
    16Department of Hematology and Stem Cell Transplantation, West-German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
    17Department of Hematology and Stem Cell Transplantation, West-German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
    18Division of Pediatrics, Palliative and Supportive Care Section, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
    19Section of Integrated Ethics in Cancer Care, Department of Critical Care and Respiratory Care, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
    20Interdepartmental Division of Critical Care Medicine, Sinai Health System/University Health Network, University of Toronto, Toronto, ON, Canada.
    21Division of Critical Care, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
    22Service de Médecine Intensive-Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Centre & Université Paris Cité, Paris, France.
    23Department of Critical Care, NHS Greater Glasgow and Clyde, Glasgow, UK; School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK.
    24Institute of Cardiometabolism and Nutrition, INSERM, UMRS_1166-ICAN, Sorbonne Université, Paris, France; Service de médecine intensive-réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, Paris, France.
    25Interdisciplinary Medical Intensive Care (IMIT), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
    26Intensive Care Unit 13i2, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
    27Department of Hematology and Oncology, University Hospital, LMU Munich, Munich, Germany.
    28Division of Pulmonary and Critical Care Medicine, Department of Medicine and Department of Oncology, Johns Hopkins University, Baltimore, MD, USA.
    29Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
    30Stem Cell Transplantation Unit, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
    31Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, Netherlands.
    32Cardiac Surgery Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
    33Pediatric Transplant and Cellular Therapy, Duke University, Durham, NC, USA.
    34Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MA, USA.
    Abstract

    Combined advances in haematopoietic cell transplantation (HCT) and intensive care management have improved the survival of patients with haematological malignancies admitted to the intensive care unit. In cases of refractory respiratory failure or refractory cardiac failure, these advances have led to a renewed interest in advanced life support therapies, such as extracorporeal membrane oxygenation (ECMO), previously considered inappropriate for these patients due to their poor prognosis. Given the scarcity of evidence-based guidelines on the use of ECMO in patients receiving HCT and the need to provide equitable and sustainable access to ECMO, the European Society of Intensive Care Medicine, the Extracorporeal Life Support Organization, and the International ECMO Network aimed to develop an expert consensus statement on the use of ECMO in adult patients receiving HCT. A steering committee with expertise in ECMO and HCT searched the literature for relevant articles on ECMO, HCT, and immune effector cell therapy, and developed opinion statements through discussions following a Quaker-based consensus approach. An international panel of experts was convened to vote on these expert opinion statements following the Research and Development/University of California, Los Angeles Appropriateness Method. The Appraisal of Guidelines for Research and Evaluation statement was followed to prepare this Position Paper. 36 statements were drafted by the steering committee, 33 of which reached strong agreement after the first voting round. The remaining three statements were discussed by all members of the steering committee and expert panel, and rephrased before an additional round of voting. At the conclusion of the process, 33 statements received strong agreement and three weak agreement. This Position Paper could help to guide intensivists and haematologists during the difficult decision-making process regarding ECMO candidacy in adult patients receiving HCT. The statements could also serve as a basis for future research focused on ECMO selection criteria and bedside management.


    Copyright © 2023 Elsevier Ltd. All rights reserved.

    Publikations ID: 36924784
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