Extracorporeal membrane oxygenation in the management of oncologic critical illness

Extracorporeal membrane oxygenation (ECMO) has evolved from a last-resort intervention for severe cardiopulmonary failure to a viable support modality across a range of critical care contexts. Its use in oncology, however, remains controversial due to the complex interplay between malignancy, immunosuppression, coagulopathy, and resource allocation. This review analyzes the current evidence regarding ECMO application in cancer patients, focusing on clinical indications, outcomes, and decision-making frameworks. ECMO may be considered in four principal oncologic settings: rescue therapy for reversible cardiorespiratory failure, perioperative support during high-risk tumor resections, bridge-to-therapy in treatment-responsive malignancies, and selective use in post–hematopoietic stem cell transplantation (HSCT) cases. Evidence suggests that cancer should be viewed as a relative, not absolute, contraindication to ECMO. Patients with solid tumors, particularly when ECMO is planned or used as a bridge to curative therapy, demonstrate survival rates comparable to non-cancer cohorts in selected studies. Conversely, outcomes are poor among those with hematologic malignancies or post-HSCT status due to profound immunosuppression and bleeding risk. Ethical and logistical challenges, including cost, futility, and proportionality of care, underscore the necessity for multidisciplinary, individualized decision-making. Advances in technology, anticoagulation management, and oncologic therapies may expand ECMO’s future role in cancer care with subsequent nursing implications.