Acute respiratory distress syndrome in patients with cancer: the YELENNA prospective multinational observational cohort study.

Summary

In a 13-country prospective cohort of 715 cancer patients with ARDS, 90-day mortality was 73.2% overall and 82.2% in severe ARDS. Venovenous ECMO did not confer a survival benefit in severe ARDS, even after double-adjusted overlap and propensity weighting.

Key Findings

• Overall 90-day mortality was 73.2%; in severe ARDS, 82.2%.
• Independent predictors of higher 90-day mortality: older age, peripheral vascular disease, severe ARDS at inclusion, acute kidney injury, and ICU admission as a time-limited trial.
• Lymphoma was associated with lower 90-day mortality.
• Venovenous ECMO showed no survival benefit in severe ARDS (82.6% vs 80.7%; P=0.89); adjusted HR 1.12 (95% CI 0.65–1.94; P=0.69).

Clinical Implications

For cancer patients with severe ARDS, ECMO may not improve survival; discussions should focus on realistic goals of care, patient values, and selection criteria rather than default escalation. Risk stratification should consider age, peripheral vascular disease, severity, and acute kidney injury.

Limitations

• Observational design limits causal inference and residual confounding cannot be excluded.
• Potential selection bias for ECMO candidacy and heterogeneity in cancer types and treatments.

Future Directions

Define selection criteria for ECMO in cancer-associated ARDS; prospective registries or pragmatic trials focusing on specific cancer subgroups; incorporate patient-centered outcomes and goals-of-care frameworks.