Successful extracorporeal membrane oxygenation in four children with malignant disease and severe Pneumocystis carinii pneumonia

Background. Toxic deaths due to intensified treatment are of increasing con cern in view of the generally improved prognosis for children with malignan cies. Pneumocystis carinii pneumonia (PCP) during immunosuppressive treatme nt in children with malignancies is a severe complication with a poor progn osis if mechanical ventilation is required. Extracorporeal membrane oxygena tion (ECMO) is a recognized technique that provides temporary respiratory s upport for patients with intractable respiratory failure. Procedure. We her e report successful ECMO support in four children with PCP, secondary to ch emotherapy-induced immunosuppression, in whom the respiratory situation det eriorated despite pharmacological treatment and mechanical ventilation. The duration of ECMO was 7-43 days. Results. Three children with acute lymphob lastic leukemia recovered from their PCP to continue chemotherapy and are n ow in complete continuous remission. Their pulmonary function normalized co mpletely during 6-12 months after ECMO therapy. One child with a primitive neuroectodermal tumor survived the PCP and was off ECMO for 11 days before succumbing to unrelated complications. Conclusions. We conclude that ECMO o ffers an important means of respiratory support in children with severe PCP that can also be adopted during treatment for malignant disease. Med. Pedi atr. Oncol. 32:25-31, 1999. (C) 1999 Wiley-Liss, Inc.