Buying Time: The Use of Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplantation in Pediatric Patients

Abstract

Purpose To describe our experience to date of 4 children with end stage lung disease who have been bridged with Extracorporeal Membrane Oxygenation (ECMO) to successful lung transplantation (LTx) in our institution. Methods and Materials Between March 2006 and June 2012, a total of 21 pediatric patients (aged 6 to 17 years of age) successfully underwent LTx within The Alfred’s combined adult and pediatric lung transplantation program. This included 4 children who were bridged on ECMO prior to LTx according to the “ECMO bridge to transplant” protocol, and whose clinical notes and outcomes were reviewed. Results The four pediatric patients who were ECMO bridged to LTx were compared to 17 pediatric patients who were transplanted over the same time period but did not require ECMO prior to LTx. Three month survival was 88.2% in those who were not bridged from ECMO and 100% for patients who were bridged to LTx by ECMO. Two patients underwent cut-down lobar LTx. The median length of stay in ICU post LTx was 14 days in the ECMO group compared to 7 days in the non ECMO group of patients (See table 3). The total length of post-operative hospital stay was also greater in the ECMO group with a median of 32 days compared with 25 days in the patients without ECMO support. Conclusions Whilst our report describes excellent short and medium-term outcomes in a small number of children who have been bridged to transplant on ECMO, it is important to re-iterate that the very the decision to offer ECMO should be made on a case-by-case basis and that best transplant outcomes will arise when potential transplant recipients are identified early, are educated with regard to transplantation, and engage in pulmonary rehabilitation whilst on the waiting list.