title: Successful Semi-Ambulatory Veno-Arterial Extracorporeal Membrane Oxygenation Bridge to Heart-Lung Transplantation in a Very Small Child.
abstract: Lung transplantation (LTx) may be denied for children on extracorporeal membrane oxygenation (ECMO) due to high risk of cerebral hemorrhage. Rarely has successful LTx been reported in children over 10 years of age receiving awake or ambulatory veno-venous ECMO. LTx following support with ambulatory veno-arterial ECMO (VA ECMO) in children has never been reported to our knowledge. We present the case of a 4-year-old, 12-kg child with heritable pulmonary artery hypertension and refractory right ventricular failure. She was successfully bridged to heart-lung transplantation (HLTx) using ambulatory VA ECMO. Initial resuscitation with standard VA ECMO was converted to an ambulatory circuit using Berlin heart cannulae. She was extubated and ambulating around her bed while on VA ECMO for 40 days. She received an HLTx from an oversized marginal lung donor. Despite a cardiac arrest and Grade 3 primary graft dysfunction, she made a full recovery without neurological deficits. She achieved 104% force expiratory volume in 1 s 33 months post-HLTx. Ambulatory VA ECMO may be a useful strategy to bridge very young children to LTx or HLTx. Patient tailored ECMO cannulation, minimization of hemorrhage, and thrombosis risks while on ECMO contributed to a successful HLTx in our patient.
authors: Department of Pediatrics, Division of Pediatric Respiratory Medicine, McMaster University, Hamilton, Ontario, Canada.
authors: J Y W
authors: JY
authors: Wong
authors: Department of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada.
authors: H
authors: H
authors: Buchholz
authors: Department of Pediatrics, Pediatric Cardiac Intensive Care Unit, University of Alberta, Edmonton, Alberta, Canada.
authors: L
authors: L
authors: Ryerson
authors: Department of Pediatrics, Pediatric Intensive Care Unit, University of Alberta, Edmonton, Alberta, Canada.
authors: A
authors: A
authors: Conradi
authors: Department of Pediatrics, Pediatric Intensive Care Unit, University of Alberta, Edmonton, Alberta, Canada.
authors: I
authors: I
authors: Adatia
authors: Department of Pediatrics, Division of Pediatric Cardiology, University of Alberta, Edmonton, Alberta, Canada.
authors: J
authors: J
authors: Dyck
authors: Department of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada.
authors: I
authors: I
authors: Rebeyka
authors: Department of Medicine, Division of Respiratory Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors: D
authors: D
authors: Lien
authors: Department of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada.
authors: J
authors: J
authors: Mullen
mesh_terms: D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D016040:Lung Transplantation
keywords: Clinical research; extracorporeal membrane oxygenation (ECMO); lung disease; lung transplantation; pediatrics; practice; pulmonology