Extracorporeal membrane oxygenation in pediatric cardiac transplantation.
BACKGROUND
We reviewed a single institution experience with extracorporeal membrane oxygenation (ECMO) in the perioperative management of cardiac transplantation.


METHODS
Of all pediatric cardiac transplant candidates (1984-2003), patients requiring ECMO pretransplantation/posttransplantation were identified, with particular attention to use of ECMO as a bridge to transplantation. Parameters reviewed included proportionate survival, incidence of pre-ECMO cardiac arrest, ECMO duration, and United Network for Organ Sharing list time.


RESULTS
Three hundred patients were listed for transplantation. Twenty-nine required ECMO: 18 pretransplant, 3 pretransplant and posttransplant, 6 posttransplant, and 2 for delayed acute rejection. There were 21 bridge-to-transplant candidates, of which 10 eventually transplanted with 60% survival; 11 not transplanted had no survivors (P = .004). Thirteen of 21 had cardiac arrest pre-ECMO with 1 (8%) survivor; 8 of 21 had no arrest with 5 (63%) survivors (P = .014). Mean ECMO duration and United Network for Organ Sharing list times between transplanted and not transplanted were not significant. Nine received ECMO posttransplantation for cardiopulmonary support; 5 (56%) of 9 survived. Two patients supported with ECMO for rejection-related cardiovascular collapse survived.


CONCLUSIONS
ECMO can bridge children to cardiac transplantation. Survival is significantly impaired in bridge-to-transplant candidates stratified by pre-ECMO cardiac arrest. ECMO can also help transition from cardiopulmonary bypass after transplantation and provide effective support during acute rejection.
Bae
Jae-O
JO
Division of Pediatric Surgery, Columbia University, College of Physicians and Surgeons, Children's Hospital of New York, New York, NY 10032-3784, USA. job14@columbia.edu
Frischer
Jason S
JS
Waich
Margarita
M
Addonizio
Linda J
LJ
Lazar
Eric L
EL
Stolar
Charles J H
CJ
D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation; D006084:Graft Rejection / Q000628:therapy; D006323:Heart Arrest / Q000401:mortality; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000379:methods*; D006801:Humans; D007223:Infant; D010372:Pediatrics; D011182:Postoperative Care; D011300:Preoperative Care; D016019:Survival Analysis; D016896:Treatment Outcome