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.
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
Jae-O
JO
Bae
Jason S
JS
Frischer
Margarita
M
Waich
Linda J
LJ
Addonizio
Eric L
EL
Lazar
Charles J H
CJ
Stolar
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