PURPOSE: Acute respiratory failure is the leading reason for intensive care unit (ICU) admission among critically ill patients with cancer. We aimed to describe the clinical characteristics, risk factors, and outcomes of patients with cancer and acute respiratory distress syndrome (ARDS) and to evaluate associations of venovenous extracorporeal membrane oxygenation (ECMO) with outcomes in the subgroup with severe ARDS. METHODS: We conducted a multinational, prospective, observational cohort study of patients with cancer and ARDS in 13 countries in Europe and North America. The primary endpoint was 90-day mortality. RESULTS: Among 715 included patients, 73.4% had hematologic malignancies and 26.6% solid tumors; 31.2% had undergone hematopoietic stem-cell transplantation (168 allogeneic). ICU, hospital, and 90-day mortality rates were 55.3%, 70.9%, and 73.2%, respectively. By multivariate analysis, independent predictors of higher 90-day mortality were older age, peripheral vascular disease, severe ARDS at inclusion, acute kidney injury, and ICU admission as a time-limited trial (vs. full code). Conversely, lymphoma was associated with lower 90-day mortality. Among the 322 patients (45.7%) with severe ARDS at inclusion, 90-day mortality was 82.2%; with no difference between patients who received ECMO (n = 58, 18%) and those who did not (82.6% vs. 80.7%, P = 0.89). This finding remained unchanged in a double-adjusted overlap- and propensity-weighted Cox mixed-effects model (adjusted hazard ratio, 1.12; 95% confidence interval 0.65-1.94; P = 0.69). CONCLUSION: Patients with cancer and ARDS, particularly severe forms, experience high 90-day mortality, irrespective of ECMO use. These findings suggest a need for nuanced ICU goals-of-care discussions and raise concerns about the generalizability of ECMO guidelines to this population.

Critical Care Department Hospital Universitari Vall d'Hebron Vall d'Hebron Institut de Recerca SODIR Barcelona Spain

Department of Anesthesia and Intensive Care Istituto Mediterraneo per i Trapianti e Terapie ad alta Specializzazione Palermo Italy

Department of Anesthesiology and Intensive Care 1 Medical Faculty General University Hospital Prague Czechia

Department of Clinical Medicine Trinity College Dublin St James Hospital Dublin Ireland

Department of Critical Care King's College Hospital NHS Foundation Trust London UK

Department of Emergency Department of Anesthesiology and Intensive Care Medicine and Institute for Medical Humanities 1st School of Medicine Agostino Gemelli University Hospital Università Cattolica del Sacro Cuore Rome Italy

Department of Hematology and Stem Cell Transplantation Intensive Care Unit West German Cancer Center University of Duisburg Essen University Hospital Essen Essen Germany

Department of Intensive Care Hôpital Universitaire de Bruxelles Brussels Belgium

Department of Intensive Care Medicine Multidisciplinary Intensive Care Research Organization St James's Hospital Dublin Ireland

Department of Intensive Care Medicine Radboud University Medical Centre Nijmegen The Netherlands

Department of Internal Medicine 2 Intensive Care Unit School of Medicine University Hospital Rechts der Isar Technical University of Munich Munich Germany

Department of Internal Medicine Intensive Care Unit Medical University of Graz Graz Austria

Department of Internal Medicine School of Medicine in Pilsen Charles University Teaching Hospital Pilsen Pilsen Czech Republic

Department of Medicine 1 Intensive Care Unit 13i2 Medical University of Vienna Vienna Austria

Department of Medicine and Interdepartmental Division of Critical Care Medicine Mount Sinai Hospital University of Toronto Toronto Canada

Dept of Immunology Oslo University Hospital Oslo Norway

Division of Emergencies and Critical Care Oslo University Hospital Oslo Norway

Division of Pulmonary and Critical Care Medicine Penn State Health Hershey Medical Center Hershey USA

Medical Intensive Care Unit Hôpital Saint Louis and INSERM UMR1342 Institut de Recherche Saint Louis Université Paris Cité Paris France

Medical Intensive Care Unit Internal Medicine Department Hospital Clínic de Barcelona IDIBAPS Universitat de Barcelona Barcelona Spain

Pulmonary and Critical Care Medicine Mayo Clinic Rochester USA

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