Extracorporeal membrane oxygenation in adults receiving haematopoietic cell transplantation: an international expert statement

Matteo Di Nardo*, Graeme MacLaren, Peter Schellongowski, Elie Azoulay, Amy E. DeZern, Cristina Gutierrez, Massimo Antonelli, Marta Antonini, Gernot Beutel, Alain Combes, Rodrigo Diaz, Ibrahim Fawzy Hassan, Jo-Anne Fowles, In-Seok Jeong, Matthias Kochanek, Tobias Liebregts, Catherina Lueck, Karen Moody, Jessica A. Moore, Laveena MunshiMatthew Paden, Frederic Pene, Kathryn Puxty, Matthieu Schmidt, Dawid Staudacher, Thomas Staudinger, Joachim Stemmler, R. Scott Stephens, Lisa Vande Vusse, Philipp Wohlfarth, Roberto Lorusso, Antonio Amodeo, Kris M. Mahadeo, Daniel Brodie

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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.
Original languageEnglish
Pages (from-to)477-492
Number of pages16
JournalThe Lancet Respiratory medicine
Volume11
Issue number5
DOIs
Publication statusPublished - 1 May 2023

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