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

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.
Competing Interests: Declaration of interests DB has received research support from and provided consultation to LivaNova; has been on the medical advisory boards for Abiomed, Xenios, Medtronic, Inspira, and Cellenkos; and is the president-elect of ELSO and the Chair of the Executive Committee of the International ECMO Network. MP and DB are on the ELSO board of directors. GM is the president of ELSO. EA is the president-elect of the European Society of Intensive Care Medicine. MDN and RL are medical advisory board members for Eurosets. RL is a consultant for Medtronic and LivaNova. AC reports grants from Getinge, and personal fees from Getinge, Baxter, and Xenios, outside of the submitted work. MS reports personal fees from Getinge, Drager, and Xenios, outside of the submitted work. PS reports personal fees from Getinge, and scientific grants from the European Society of Intensive Care Medicine and the European Commission (Horizon 2020 Fast Track to Innovation; NCT04115709). EA has received fees for lectures from Gilead, Pfizer, Sanofi, and Alexion, and research grants from Pfizer and Fisher & Paykel. FP has received fees for lectures from Gilead and research grants from Alexion. MA has received research grants from GE and Toray, and board participation fees from Fisher & Paykel, Gilead, MSD, and Pfizer. MS has received fees for lectures from Getinge, Fresenius Medical Care, Baxter, and Xenios. All other authors declare no competing interests.
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