Extracorporeal Membrane Oxygenation for Patients With Thoracic Neoplasms: An Extracorporeal Life Support Organization (ELSO) Registry Analysis

Background: Extracorporeal membrane oxygenation (ECMO) is used in the management of severe cardiopulmonary failure, but the indication in the oncologic population has not been clearly established. Among malignant neoplasms, thoracic neoplasms are unique in their potential direct impact on cardiopulmonary function. This study aimed to better define the role of ECMO for thoracic neoplasms. Methods: The Extracorporeal Life Support Organization registry was queried for patients older than 18 years with an International Classification of Diseases code of thoracic neoplasm during the past 2 decades (2000-2019). Outcomes and clinical data including associated procedures were analyzed. Results: There were 498 patients who met inclusion criteria. The neoplasms included 34 upper airway, 247 lung, 45 unspecified respiratory tract, 4 pleura, 19 heart, 40 mediastinum, 108 esophagus, and 1 unspecified; 198 patients survived to discharge (39.8%; “survival”). Upper airway neoplasms were associated with better survival (73.5%; P = .005), whereas lung neoplasms were associated with worse survival (30.0%; P < .001) compared with all adult ECMO runs. Of the 498 cases, 94 (18.9%) were started after thoracic or airway procedures. Favorable survival was associated with tracheal procedures (66.7% [n = 9]), whereas poor survival was seen with pneumonectomy (13.3% [n = 30]), any type of lung resection (23.7% [n = 76]), and esophageal procedures (21.4% [n = 14]). Conclusions: The outcome for ECMO among patients with a thoracic neoplasm is variable, depending on clinical factors including tumor subtype and type of associated procedure. Clinicians should continue to focus on individualized patient selection to achieve optimal results.