title: Utility of extracorporeal membrane oxygenation for early graft failure following heart transplantation in infancy.
abstract: BACKGROUND
  Extracorporeal membrane oxygenation (ECMO) is widely used for postcardiotomy cardiogenic shock in children. However, the efficacy of ECMO for early post-heart transplant graft failure in infants has not been reported. Our aims were to determine: (1) the utility of ECMO in infants with severe donor-heart dysfunction, (2) predictors for requiring ECMO, and (3) the long-term outcome of surviving ECMO patients.
  
  
  METHODS
  All infants (age < 6 months at listing) undergoing heart transplantation were reviewed. Diagnostic categories were hypoplastic left heart syndrome (HLHS) and non-HLHS (complex congenital heart disease and cardiomyopathies). Continuous and categorical comparisons were by Wilcoxon's rank sum test and Fisher's exact test respectively.
  
  
  RESULTS
  14 (12 HLHS, 2 non-HLHS) of 63 (46 HLHS, 17 non-HLHS) infants were placed on ECMO. Ten patients (71%) were successfully weaned from ECMO and 8 (57%) were discharged alive. All ECMO hospital survivors remain alive (mean follow-up 36.2 +/- 21.4 months, range 13.1-77.6 months). Mean duration of ECMO support was 68 hours in weaned patients vs 144 hours (p = 0.19) in nonweaned patients, and 64 hours in survivors vs 123 hours (p = 0.35) in nonsurvivors. ECMO deaths were due to sepsis (n = 3), intractable pulmonary hypertension (n = 2), and intracranial bleed (n = 1). Neurologic deficits occurred in 2 survivors. Median ICU and hospital stays for ECMO survivors were 29 and 33 days vs 7 (p = 0.0003) and 9 (p = 0.0004) days for non-ECMO patients. Age listed, age transplanted, wait time, body weight, donor/recipient weight ratio, total ischemia time, and diagnosis did not predict the need for ECMO.
  
  
  CONCLUSIONS
  (1) ECMO is useful for post-heart transplant circulatory support in infants with early graft failure. (2) All survivors were weaned in fewer than 4 days. (3) Three-year survival of ECMO hospital survivors has been high, but neurologic complications are prevalent.
authors.affiliation: Division of Cardiothoracic Surgery, University of Colorado Health Sciences Center, Denver, Colorado, USA. mitchell.max@tchden.org
authors.forename: M B
authors.initials: MB
authors.lastname: Mitchell
authors.forename: D N
authors.initials: DN
authors.lastname: Campbell
authors.forename: M R
authors.initials: MR
authors.lastname: Bielefeld
authors.forename: T
authors.initials: T
authors.lastname: Doremus
mesh_terms: D009202:Cardiomyopathies / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects; D006330:Heart Defects, Congenital / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery*; D007223:Infant; D011183:Postoperative Complications / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors