Extracorporeal membrane oxygenation as a bridge to cardiac transplantation in children.
The feasibility and efficacy of extracorporeal membrane oxygenation (ECMO) as a bridge to cardiac transplantation was examined in 6 pediatric patients who suffered irreversible myocardial failure after undergoing surgery for congenital heart defects. The mean time of ECMO support was 260.5 h, range 101-402 h. Three patients underwent transplantation, 2 of whom are long-term survivors. Progressive hypotension as a result of capillary leak syndrome precluded further ECMO support in the other 3 patients. Overall, 2 of the 6 patients survived. Major complications were encountered in 4 patients including bleeding in 2, a seizure in 1, and renal failure in 3, 2 of whom recovered renal function after transplantation. Infection did not occur in any of the 6 patients. Exchanging ECMO components was performed with no difficulties; these exchanges included a centrifugal pump once for 3 patients and a membrane oxygenator once for 2 patients. Our results indicate that ECMO can safely keep critically ill pediatric transplant candidates alive for more than 1 week with a low incidence of multiple organ failure.
Ishino
K
K
Department of Thoracic and Cardiovascular Surgery, German Heart Institute of Berlin, Germany.
Weng
Y
Y
Alexi-Meskishvili
V
V
Loebe
M
M
Uhlemann
F
F
Lange
P E
PE
Hetzer
R
R
D000293:Adolescent; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000592:standards*; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006333:Heart Failure / Q000601:surgery*; D016027:Heart Transplantation / Q000639:trends*; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000401:mortality; D016896:Treatment Outcome