Indications and Outcomes for Temporary Mechanical Circulatory Support in Pediatric Patients with Cardiac Failure.

Abstract

Temporary continuous-flow ventricular assist devices (cfVAD) and extracorporeal membrane oxygenation (ECMO) are options for temporary mechanical circulatory support in pediatric patients. Despite the increase in temporary cfVAD use, the literature describing its use in pediatrics is limited. This was a single-center retrospective review of temporary cfVAD and a cohort of similar ECMO patients between January 1, 2011, and June 30, 2016, in patients <19 years of age. Thirteen patients underwent temporary cfVAD placement and 11 patients underwent ECMO cannulation for similar indications during the study period. Precannulation data were not statistically different, except for higher lactate and lower pH in the ECMO cohort. Median length of cfVAD support was 20 days (range 6-227), compared with 9 days (range 1-15) on ECMO. Primary outcome for cfVAD patients was one decannulated with recovery, six transplanted, and six died, compared with ECMO patients with five decannulated with recovery, three transplanted after conversion to durable VAD, and three died. No patients were transplanted directly from ECMO. This review provides new evidence that temporary cfVAD use can be used to support pediatric patients more than longer periods of time compared with ECMO, with transition to durable VAD and transplant.