Extracorporeal membrane oxygenation for perioperative support in pediatric heart transplantation

Abstract

Extracorporeal membrane oxygenation has demonstrated effectiveness for cardiopulmonary support in a variety of clinical situations. This article reviews the cases in which extracorporeal membrane oxygenation was used as an adjunct to pediatric cardiac transplantation. Twenty children, aged 7 days to 17 years, with cardiac failure refractory to conventional therapy received extracorporeal membrane oxygenation for 6 to 192 hours. In 4 cases it was used as a bridge to transplantation; in 10 cases it facilitated resuscitation of the cardiac allograft in the immediate postoperative period; and in 6 cases it complemented therapy for severe rejection in the late postoperative period. Twelve patients survived extracorporeal membrane oxygenation, 7 of whom lived more than 8 months. One long-term survivor was in the bridge-to-transplant group, 4 in the immediate postoperative group, and 2 in the rejection group. All survivors have normal cardiac allograft function. These data suggest that extracorporeal membrane oxygenation can be used to support profound cardiac failure in the pediatric heart transplant patient as a bridge to transplantation, in the resuscitation of the cardiac allograft, or to supplement a rejecting allograft.