Extracorporeal Membrane Oxygenation for Perioperative Support in Neonatal and Pediatric Cardiac Transplantation

Abstract

Currently there is a lack of consensus on guidelines in the clinical application of extracorporeal membrane oxygenation (ECMO) in neonatal and pediatric cardiac transplantation patients. In this context, given the limited data presently available through the Extracorporeal Life Support Organization (ELSO) Registry, we conducted a preliminary survey to specifically evaluate the practice of using ECMO as a bridge to cardiac transplantation or as posttransplantation therapy for failure to wean from cardiopulmonary bypass or graft failure. We received responses to our questionnaire from 95 of 118 (81%) centers located in the U.S.A. and abroad. Of the 95 centers that responded, 36 were performing neonatal/pediatric cardiac transplants, with 29 centers reporting the concomitant use of ECMO to support cardiac transplant patients. There was wide variability in the responses from the 29 centers to a selected list of relative ECMO contraindications. However, only 7 centers had specific ECMO entry criteria for cardiac transplant patients. Fifteen of the 29 centers provided relevant data on cardiac transplant patients including the proportions of neonatal (11 of 37) and pediatric (63 of 217) patients requiring ECMO; neonatal (2 of 5) and pediatric (16 of 27) patients surviving to transplant; and neonatal (1 of 5) and pediatric (12 of 27) patients surviving to hospital discharge. These findings confirm the important role of ECMO in providing perioperative support in neonatal and pediatric cardiac transplantation patients. However, the lack of consensus among centers contributes to uncertainty in the decision making process to offer ECMO and to utilize ECMO effectively in this high risk population. We recommend that institution-specific information be collected, either using the ELSO Registry (or by a similar multicentric database) to develop specific guidelines for ECMO applications in cardiac transplant patients, and to carefully monitor and follow up EMCO treated patients to further evaluate the efficacy of this limited resource.

Use of extracorporeal membrane oxygenation in pediatric thoracic organ transplantation

“…Extracorporeal membrane oxygenation (ECMO) remains the most commonly used mechanical circulatory support system in children. Numerous case reports and series have described the use of ECMO as a bridge to transplantation or for support after thoracic organ transplantation [1][2][3][4][5][6] ; however, the number of patients included in most of these reports has been small, The goal of this study was to retrospectively evaluate our experience with the use of ECMO in children immediately before or after thoracic organ transplantation at a single institution. For the purposes of this study, bridge to transplant was defined as the use of ECMO in any child who was listed for primary thoracic organ transplantation at some time during the period of ECMO support.…”

Extracorporeal membrane oxygenation to cardiopulmonary bypass with a single circuit exposure

“…3 Support prolongs life, allowing some patients to survive until transplantation. 3,6,7 The Extracorporeal Life Support Organization reports the average ECMO run for a heart transplant patient was 131 hours with a 45% survival as of July 2003. 5 Patients on ECMO are exposed to the surface area of the oxygenator and circuit tubing.…”

Extracorporeal Membrane Oxygenation

“…Hastaların çoğunluğu yenidoğan olup %53, %25 pediatrik ve %23 yetişkindir. Bunların dağılımına bakarsak; 41.300 (%63) üzerinde hasta respiratuar yetmezlik, 18.700 (%29) üzerinde hasta kardiyak yetmezlik ve 5.100 (%8) üzerinde hasta ekstrakorporal kardiyopulmoner resüsitasyon için destek almıştır (43,44) .…”

“…2016 yılında risk tahmin skorları üzerine birkaç önemli adım atılmıştır (40)(41)(42) . 18.700 (%29) üzerinde hasta kardiyak yetmezlik ve 5.100 (%8) üzerinde hasta ekstrakorporal kardiyopulmoner resüsitasyon için destek almıştır (43,44) . Kardiyak ve pulmoner yetmezlik gibi her yaşta hasta için hayatı tehdit eden durumlar olmaya devam ettikçe; ECMO veya diğer alternatif yöntemler üzerinde arayışlar ve detaylı çalışmalar sürecektir.…”