Issue |
J Extra Corpor Technol
Volume 50, Number 1, March 2018
|
|
---|---|---|
Page(s) | 61 - 64 | |
DOI | https://doi.org/10.1051/ject/201850061 | |
Published online | 15 March 2018 |
Case Reports
Successful Use of Extracorporeal Life Support in a Hematopoietic Stem Cell Transplant Patient with Neuroblastoma
* Division of Pediatric Critical Care Medicine, Emory University School of Medicine, Atlanta, Georgia;
† Children’s Healthcare of Atlanta, Atlanta, Georgia;
‡ Division of Pediatric Hematology Oncology, Emory University of School of Medicine, Atlanta, Georgia; and
§ Aflac Cancer and Blood Disorders Center, Atlanta, Georgia
Address correspondence to: Feifei Z. Williams, MD, Department of Pediatric Cardiology, Children’s Healthcare of Atlanta at Egleston, 1405 Clifton Rd NE, Atlanta, GA 30322. E-mail: williamsf2@kidsheart.com
Received:
27
July
2017
Accepted:
23
October
2017
Respiratory failure associated with hematopoietic stem cell transplantation (HSCT) has been considered a contraindication for use of extracorporeal membrane oxygenation (ECMO) at many centers. We describe a child with neuroblastoma and hypoxemic respiratory failure following HSCT who was successfully managed with veno-venous (VV) ECMO. The patient was an 18-month-old female with high-risk neuroblastoma status post tumor resection, chemotherapy, autologous HSCT, and primary site radiation. On day 113 posttransplant while receiving maintenance immunotherapy, she had an acute respiratory decompensation because of rhinovirus, aspiration pneumonia, and capillary leak syndrome. The patient was intubated and transitioned to a high frequency oscillatory ventilation and inhaled nitric oxide. Because of refractory hypoxemia, she was cannulated for VV ECMO. She was weaned and decannulated after 7.5 days on ECMO, then subsequently transferred for inpatient rehabilitation. The most recent Extracorporeal Life Support Organization registry analysis showed low survival (3/29) in patients requiring ECMO after HSCT, and 2 of 3 survivors had nononcological diagnoses. However, our patient’s outcome suggests that HSCT status should not be an absolute contraindication. The presence of a reversible single organ failure and the absence of significant bleeding risk in an engrafted, neurologically intact, and non-neutropenic HSCT patient with a favorable prognosis can support the potential benefit of ECMO.
Key words: acute respiratory failure / malignancy / neuroblastoma / hematopoietic stem cell transplantation / extracorporeal membrane oxygenation
© 2018 AMSECT
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