Extracorporeal Membrane Oxygenator Failure in a Patient With Gestational Trophoblastic Neoplasm: Possible Mechanisms and Considerations in Critical Care

Abstract

GESTATIONAL TROPHOBLASTIC neoplasms (GTN) are a rare group of gynecologic tumors consisting of a proliferation of trophoblastic tissue with variable locally invasive and metastatic potential. 1 Brown J Naumann RW Seckl MJ et al. 15 years of progress in gestational trophoblastic disease: Scoring, standardization, and salvage. Gynecol Oncol. 2017; 144: 200-207 Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar These tumors commonly present as low-risk tumors, with a persistent elevation of beta-human chorionic gonadotropin (ß-HCG) after a molar pregnancy or miscarriage, but instances of diffuse alveolar hemorrhage, 2 Montrief T Bornstein K Grant A et al. Disseminated gestational trophoblastic disease and diffuse alveolar hemorrhage treated with extracorporeal membrane oxygenation. Cureus. 2020; 12: e8064 PubMed Google Scholar acute respiratory distress syndrome (ARDS), 2 Montrief T Bornstein K Grant A et al. Disseminated gestational trophoblastic disease and diffuse alveolar hemorrhage treated with extracorporeal membrane oxygenation. Cureus. 2020; 12: e8064 PubMed Google Scholar and pulmonary embolism 3 Chung JH Yeo HJ Cho HM et al. Treatment of pulmonary tumor embolism from choriocarcinoma: Extracorporeal membrane oxygenation as a bridge through chemotherapy. Cancer Res Treat. 2017; 49: 279-282 Crossref PubMed Scopus (12) Google Scholar have been associated with high-risk GTN. These tumors generally are sensitive to chemotherapy in low-risk disease, but high-risk GTN may require a multiagent chemotherapeutic regimen. 1 Brown J Naumann RW Seckl MJ et al. 15 years of progress in gestational trophoblastic disease: Scoring, standardization, and salvage. Gynecol Oncol. 2017; 144: 200-207 Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar When successfully treated with chemotherapy, cure rates for GTN are greater than 90%. 1 Brown J Naumann RW Seckl MJ et al. 15 years of progress in gestational trophoblastic disease: Scoring, standardization, and salvage. Gynecol Oncol. 2017; 144: 200-207 Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar ,4 Seckl MJ Sebire NJ Berkowitz RS. Gestational trophoblastic disease. Lancet. 2010; 376: 717-729 Abstract Full Text Full Text PDF PubMed Scopus (527) Google Scholar Despite the favorable potential for cure when patients complete chemotherapy, critically ill patients may not clinically stabilize to a point to receive chemotherapy. In such cases of high-risk GTN in a critically ill patient, an early death rate is reported to be approximately 7%. 5 Alifrangis C Agarwal R Short D et al. EMA/CO for high-risk gestational trophoblastic neoplasia: Good outcomes with induction low-dose etoposide-cisplatin and genetic analysis. J Clin Oncol. 2013; 31: 280-286 Crossref PubMed Scopus (121) Google Scholar