Abstract
Since 1990, ECMO has been used as a bridge to cardiac transplantation in 47 patients. A review of the ACH, IRB approved, ECMO database forms the basis of this report. Statistical comparison used Fisher exact probability testing. ECMO circuitry was a roller occlusion pump with computerized assisted perfusion system technology. Trans-catheter septostomy was used for cardiac decompression in 32 (68%) patients. Diagnosis at presentation was either congenital heart disease (CHD) N=15 or cardiomyopathy (CM) N=32. Ages ranged from 1 day to 22 years (median 18 months) and weight ranged from 2.9 to 100 kg (median10 kg). The average duration of support was 242 hours (range 22-1078 hours). Overall long-term survival was 47% with 16 (34%) patients successfully bridged to cardiac transplant (of which 9 [56%] survived) and 13 (28%) successfully weaned from ECMO. Patients placed on ECMO post-cardiotomy had a 31% survival. Survival was significantly improved (p< .02) in patients with a diagnosis of CM (59%) versus those with CHD (25%). Patients with CM underwent 8 transplants with 7 survivors (88%), while in the CHD group, there were 8 transplants with only 2 survivors (25%), (p< .05). Subanalysis of the CM group revealed that patients with acute cardiomyopathy in association with a documented viral illness had a 75% chance of being weaned off ECMO without transplant. Complications on ECMO occurred in 45% of survivors and were more frequent in nonsurvivors. Infectious complications were most frequent, followed by neurological, technical ECMO problems and renal insufficiency. In conclusion, CM has a better prognosis than CHD when using ECMO as a bridge to transplant or survival. Complications are not insignificant and increase with the duration of support. ECMO for salvage and subsequent transplant in this high-risk group of patients needs critical review. Alternative support options need to be developed in the pediatric population that will allow improved outcomes comparable to those achieved by our adult support colleagues.
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