Extracorporeal membrane oxygenation in children receiving haematopoietic cell transplantation and immune effector cell therapy: an international and multidisciplinary consensus statement

Matteo Di Nardo; Ali H Ahmad; Pietro Merli; Matthew S Zinter; Leslie E Lehman; Courtney M Rowan; Marie E Steiner; Sangeeta Hingorani; Joseph R Angelo; Hisham Abdel-Azim; Sajad J Khazal; Basirat Shoberu; Jennifer McArthur; Rajinder Bajwa; Saad Ghafoor; Samir H Shah; Hitesh Sandhu; Karen Moody; Brandon D Brown; Maria E Mireles; Diana Steppan; Taylor Olson; Lakshmi Raman; Brian Bridges; Christine N Duncan; Sung Won Choi; Rita Swinford; Matt Paden; James D Fortenberry; Giles Peek; Pierre Tissieres; Daniele De Luca; Franco Locatelli; Selim Corbacioglu; Martin Kneyber; Alessio Franceschini; Simon Nadel; Matthias Kumpf; Alessandra Loreti; Roelie Wösten-Van Asperen; Orsola Gawronski; Joe Brierley; Graeme MacLaren; Kris M Mahadeo

doi:10.1016/S2352-4642(21)00336-9

Extracorporeal membrane oxygenation in children receiving haematopoietic cell transplantation and immune effector cell therapy: an international and multidisciplinary consensus statement

Lancet Child Adolesc Health. 2022 Feb;6(2):116-128. doi: 10.1016/S2352-4642(21)00336-9. Epub 2021 Dec 9.

Authors

Matteo Di Nardo¹, Ali H Ahmad², Pietro Merli³, Matthew S Zinter⁴, Leslie E Lehman⁵, Courtney M Rowan⁶, Marie E Steiner⁷, Sangeeta Hingorani⁸, Joseph R Angelo⁹, Hisham Abdel-Azim¹⁰, Sajad J Khazal¹¹, Basirat Shoberu¹¹, Jennifer McArthur¹², Rajinder Bajwa¹³, Saad Ghafoor¹², Samir H Shah¹⁴, Hitesh Sandhu¹⁴, Karen Moody¹⁵, Brandon D Brown¹¹, Maria E Mireles¹⁶, Diana Steppan¹⁷, Taylor Olson¹⁸, Lakshmi Raman¹⁹, Brian Bridges²⁰, Christine N Duncan⁵, Sung Won Choi²¹, Rita Swinford²², Matt Paden²³, James D Fortenberry²³, Giles Peek²⁴, Pierre Tissieres²⁵, Daniele De Luca²⁶, Franco Locatelli³, Selim Corbacioglu²⁷, Martin Kneyber²⁸, Alessio Franceschini²⁹, Simon Nadel³⁰, Matthias Kumpf³¹, Alessandra Loreti³², Roelie Wösten-Van Asperen³³, Orsola Gawronski³⁴, Joe Brierley³⁵, Graeme MacLaren³⁶, Kris M Mahadeo¹¹

Affiliations

¹ Pediatric Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy. Electronic address: matteo.dinardo@opbg.net.
² Department of Pediatrics, Pediatric Critical Care, Houston, TX, USA.
³ Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
⁴ Department of Pediatrics, Divisions of Critical Care and Bone Marrow Transplantation, University of California, San Francisco, CA, USA.
⁵ Pediatric Hematology-Oncology, Dana-Farber Cancer Institute, Harvard University, Boston, MA, USA.
⁶ Department of Pediatrics, Division of Critical Care, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, USA.
⁷ Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
⁸ Department of Pediatrics, Division of Nephrology, University of Washington School of Medicine, and the Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
⁹ Renal Section, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
¹⁰ Department of Pediatrics, Transplantation and Cell Therapy Program, Keck School of Medicine, University of Southern California, Children's Hospital Los Angeles, Los Angeles, CA, USA.
¹¹ Department of Pediatrics, Stem Cell Transplantation and Cellular Therapy, Houston, TX, USA; The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
¹² Division of Critical Care Medicine, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA.
¹³ Department of Pediatrics, Division of Blood and Marrow Transplantation, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
¹⁴ Division of Pediatric Critical Care Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
¹⁵ CARTOX Program, and Department of Pediatrics, Supportive Care, Houston, TX, USA.
¹⁶ Department of Pharmacy, Houston, TX, USA.
¹⁷ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹⁸ Division of Critical Care Medicine, Children's National Hospital, Washington, DC, USA.
¹⁹ Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA.
²⁰ Division of Pediatric Critical Care, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA.
²¹ University of Michigan, Rogel Cancer Center, Ann Arbor, MI, USA; Department of Pediatrics, Ann Arbor, MI, USA.
²² Department of Pediatrics, Division of Pediatric Nephrology, McGovern Medical School, The University of Texas Health Science Center, Houston, TX, USA.
²³ Pediatric Critical Care, Children's Healthcare of Atlanta, and Emory University School of Medicine, Atlanta, GA, USA.
²⁴ Congenital Heart Center, University of Florida, Gainesville, FL, USA.
²⁵ Division of Pediatric Intensive Care and Neonatal Medicine, Paris South University Hospital, Le Kremlin-Bicetre, France; Institute of Integrative Biology of the Cell, CNRS, CEA, Univ. Paris Sud, Paris Saclay University, Paris, France.
²⁶ Division of Pediatrics, Transportation and Neonatal Critical Care Medicine, APHP, Paris Saclay University Hospital, "A.Beclere" Medical Center and Physiopathology and Therapeutic Innovation Unit-INSERM-U999, Paris Saclay University, Paris, France.
²⁷ Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University of Regensburg, Regensburg, Germany.
²⁸ Division of Pediatric Critical Care Medicine, Department of Pediatrics, Beatrix Children's Hospital Groningen, Groningen, Netherlands; Critical Care, Anesthesiology, Peri-Operative and Emergency Medicine (CAPE), University Medical Centre Groningen, University of Groningen, Groningen, Netherlands.
²⁹ Department of Cardiosurgery, Cardiology, Heart and Lung Transplant, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
³⁰ Pediatric Intensive Care Unit, Imperial College Healthcare NHS Trust, London, UK.
³¹ Interdisciplinary Pediatric Intensive Care Unit, Universitäetsklinikum Tuebingen, Tuebingen, Germany.
³² Medical Library, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
³³ Department of Pediatric Intensive Care, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, Netherlands.
³⁴ Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
³⁵ Department of Pediatric Intensive Care, Great Ormond Street Hospital for Children, London, UK.
³⁶ Director of Cardiothoracic ICU, National University Health System, Singapore, Singapore; Pediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, Australia.

Abstract

Use of extracorporeal membrane oxygenation (ECMO) in children receiving haematopoietic cell transplantation (HCT) and immune effector cell therapy is controversial and evidence-based guidelines have not been established. Remarkable advancements in HCT and immune effector cell therapies have changed expectations around reversibility of organ dysfunction and survival for affected patients. Herein, members of the Extracorporeal Life Support Organization (ELSO), Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network (HCT and cancer immunotherapy subgroup), the Pediatric Diseases Working Party of the European Society for Blood and Marrow Transplantation (EBMT), the supportive care committee of the Pediatric Transplantation and Cellular Therapy Consortium (PTCTC), and the Pediatric Intensive Care Oncology Kids in Europe Research (POKER) group of the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) provide consensus recommendations on the use of ECMO in children receiving HCT and immune effector cell therapy. These are the first international, multidisciplinary consensus-based recommendations on the use of ECMO in this patient population. This Review provides a clinical decision support tool for paediatric haematologists, oncologists, and critical care physicians during the difficult decision-making process of ECMO candidacy and management. These recommendations can represent a base for future research studies focused on ECMO selection criteria and bedside management.

Publication types

Review

MeSH terms

Clinical Decision-Making / methods*
Consensus
Extracorporeal Membrane Oxygenation*
Hematopoietic Stem Cell Transplantation*
Humans
Immunotherapy*
Patient Selection*
Pediatrics
Practice Guidelines as Topic*
Societies, Medical

Grants and funding

K23 HL150244/HL/NHLBI NIH HHS/United States