Pediatric arteriovenous extracorporeal membrane oxygenation (ECMO) as a bridge to cardiac transplantation

William P. Fiser, Anji T. Yetman, Ryan J. Gunselman, James W. Fasules, Lorrie L. Baker, Carl W. Chipman, William R. Morrow, Elizabeth A. Frazier, Jonathan J. Drummond-Webb

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Abstract

Background: Since 1990, extracorporeal membrane oxygenation (ECMO) has been used as a bridge to cardiac transplantation in 47 patients. Methods: A review of the ECMO database, approved by the Arkansas Children's Hospital institutional review board, forms the basis of this report. We made statistical comparison using Fisher's exact probability testing. The ECMO circuitry was a roller occlusion pump with computer-assisted perfusion system technology. Results: Thirty-two (68%) patients underwent transcatheter septostomy for cardiac decompression. Diagnosis at presentation was either congenital heart disease (CHD, n = 15) or cardiomyopathy (n = 32). Ages ranged from 1 day to 22 years old (median, 18 months old), and weight ranged from 2.9 to 100 kg (median, 10 kg). The average duration of support was 242 hours (range, 22-1,078 hours). Overall long-term survival was 47%, with 16 (34%) patients successfully bridged to cardiac transplantation (of which 9 [56%] survived) and 13 (28%) successfully weaned from ECMO. Patients undergoing ECMO after cardiotomy had 31% survival. Survival was improved significantly (p < 0.02) in patients with cardiomyopathy (59%) vs those with CHD (20%). Patients with cardiomyopathy underwent 8 transplantations with 7 survivors (88%), whereas in the CHD group, there were 8 transplantations with only 2 survivors (25%), p < 0.05. Sub-analysis of the cardiomyopathy group revealed that patients with acute cardiomyopathy in association with documented viral illness had a 75% chance of being weaned from ECMO without undergoing transplantation. Complications during ECMO occurred in 45% of survivors and were more frequent in non-survivors. Infectious complications were most frequent, followed by neurologic complications, technical ECMO problems, and renal insufficiency. Conclusions: Patients with cardiomyopathy has a better prognosis than did those with CHD when using ECMO as a bridge to transplantation or survival. Complications are significant and increase with the duration of support. Extracorporeal membrane oxygenation for salvage and subsequent transplantation in this high-risk group of patients requires critical review. Alternative support options must be developed in the pediatric population that will allow improved outcomes, comparable with outcomes achieved in the adult population.

Original languageEnglish (US)
Pages (from-to)770-777
Number of pages8
JournalJournal of Heart and Lung Transplantation
Volume22
Issue number7
DOIs
StatePublished - Jul 1 2003

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Extracorporeal Membrane Oxygenation
Heart Transplantation
Pediatrics
Cardiomyopathies
Transplantation
Survivors
Survival
Research Ethics Committees
Decompression
Nervous System
Population
Renal Insufficiency
Heart Diseases
Perfusion
Databases
Technology
Weights and Measures

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

Cite this

Pediatric arteriovenous extracorporeal membrane oxygenation (ECMO) as a bridge to cardiac transplantation. / Fiser, William P.; Yetman, Anji T.; Gunselman, Ryan J.; Fasules, James W.; Baker, Lorrie L.; Chipman, Carl W.; Morrow, William R.; Frazier, Elizabeth A.; Drummond-Webb, Jonathan J.

In: Journal of Heart and Lung Transplantation, Vol. 22, No. 7, 01.07.2003, p. 770-777.

Research output: Contribution to journalArticle

Fiser, WP, Yetman, AT, Gunselman, RJ, Fasules, JW, Baker, LL, Chipman, CW, Morrow, WR, Frazier, EA & Drummond-Webb, JJ 2003, 'Pediatric arteriovenous extracorporeal membrane oxygenation (ECMO) as a bridge to cardiac transplantation', Journal of Heart and Lung Transplantation, vol. 22, no. 7, pp. 770-777. https://doi.org/10.1016/S1053-2498(02)00808-2
Fiser, William P. ; Yetman, Anji T. ; Gunselman, Ryan J. ; Fasules, James W. ; Baker, Lorrie L. ; Chipman, Carl W. ; Morrow, William R. ; Frazier, Elizabeth A. ; Drummond-Webb, Jonathan J. / Pediatric arteriovenous extracorporeal membrane oxygenation (ECMO) as a bridge to cardiac transplantation. In: Journal of Heart and Lung Transplantation. 2003 ; Vol. 22, No. 7. pp. 770-777.
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abstract = "Background: Since 1990, extracorporeal membrane oxygenation (ECMO) has been used as a bridge to cardiac transplantation in 47 patients. Methods: A review of the ECMO database, approved by the Arkansas Children's Hospital institutional review board, forms the basis of this report. We made statistical comparison using Fisher's exact probability testing. The ECMO circuitry was a roller occlusion pump with computer-assisted perfusion system technology. Results: Thirty-two (68{\%}) patients underwent transcatheter septostomy for cardiac decompression. Diagnosis at presentation was either congenital heart disease (CHD, n = 15) or cardiomyopathy (n = 32). Ages ranged from 1 day to 22 years old (median, 18 months old), and weight ranged from 2.9 to 100 kg (median, 10 kg). The average duration of support was 242 hours (range, 22-1,078 hours). Overall long-term survival was 47{\%}, with 16 (34{\%}) patients successfully bridged to cardiac transplantation (of which 9 [56{\%}] survived) and 13 (28{\%}) successfully weaned from ECMO. Patients undergoing ECMO after cardiotomy had 31{\%} survival. Survival was improved significantly (p < 0.02) in patients with cardiomyopathy (59{\%}) vs those with CHD (20{\%}). Patients with cardiomyopathy underwent 8 transplantations with 7 survivors (88{\%}), whereas in the CHD group, there were 8 transplantations with only 2 survivors (25{\%}), p < 0.05. Sub-analysis of the cardiomyopathy group revealed that patients with acute cardiomyopathy in association with documented viral illness had a 75{\%} chance of being weaned from ECMO without undergoing transplantation. Complications during ECMO occurred in 45{\%} of survivors and were more frequent in non-survivors. Infectious complications were most frequent, followed by neurologic complications, technical ECMO problems, and renal insufficiency. Conclusions: Patients with cardiomyopathy has a better prognosis than did those with CHD when using ECMO as a bridge to transplantation or survival. Complications are significant and increase with the duration of support. Extracorporeal membrane oxygenation for salvage and subsequent transplantation in this high-risk group of patients requires critical review. Alternative support options must be developed in the pediatric population that will allow improved outcomes, comparable with outcomes achieved in the adult population.",
author = "Fiser, {William P.} and Yetman, {Anji T.} and Gunselman, {Ryan J.} and Fasules, {James W.} and Baker, {Lorrie L.} and Chipman, {Carl W.} and Morrow, {William R.} and Frazier, {Elizabeth A.} and Drummond-Webb, {Jonathan J.}",
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AU - Fiser, William P.

AU - Yetman, Anji T.

AU - Gunselman, Ryan J.

AU - Fasules, James W.

AU - Baker, Lorrie L.

AU - Chipman, Carl W.

AU - Morrow, William R.

AU - Frazier, Elizabeth A.

AU - Drummond-Webb, Jonathan J.

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N2 - Background: Since 1990, extracorporeal membrane oxygenation (ECMO) has been used as a bridge to cardiac transplantation in 47 patients. Methods: A review of the ECMO database, approved by the Arkansas Children's Hospital institutional review board, forms the basis of this report. We made statistical comparison using Fisher's exact probability testing. The ECMO circuitry was a roller occlusion pump with computer-assisted perfusion system technology. Results: Thirty-two (68%) patients underwent transcatheter septostomy for cardiac decompression. Diagnosis at presentation was either congenital heart disease (CHD, n = 15) or cardiomyopathy (n = 32). Ages ranged from 1 day to 22 years old (median, 18 months old), and weight ranged from 2.9 to 100 kg (median, 10 kg). The average duration of support was 242 hours (range, 22-1,078 hours). Overall long-term survival was 47%, with 16 (34%) patients successfully bridged to cardiac transplantation (of which 9 [56%] survived) and 13 (28%) successfully weaned from ECMO. Patients undergoing ECMO after cardiotomy had 31% survival. Survival was improved significantly (p < 0.02) in patients with cardiomyopathy (59%) vs those with CHD (20%). Patients with cardiomyopathy underwent 8 transplantations with 7 survivors (88%), whereas in the CHD group, there were 8 transplantations with only 2 survivors (25%), p < 0.05. Sub-analysis of the cardiomyopathy group revealed that patients with acute cardiomyopathy in association with documented viral illness had a 75% chance of being weaned from ECMO without undergoing transplantation. Complications during ECMO occurred in 45% of survivors and were more frequent in non-survivors. Infectious complications were most frequent, followed by neurologic complications, technical ECMO problems, and renal insufficiency. Conclusions: Patients with cardiomyopathy has a better prognosis than did those with CHD when using ECMO as a bridge to transplantation or survival. Complications are significant and increase with the duration of support. Extracorporeal membrane oxygenation for salvage and subsequent transplantation in this high-risk group of patients requires critical review. Alternative support options must be developed in the pediatric population that will allow improved outcomes, comparable with outcomes achieved in the adult population.

AB - Background: Since 1990, extracorporeal membrane oxygenation (ECMO) has been used as a bridge to cardiac transplantation in 47 patients. Methods: A review of the ECMO database, approved by the Arkansas Children's Hospital institutional review board, forms the basis of this report. We made statistical comparison using Fisher's exact probability testing. The ECMO circuitry was a roller occlusion pump with computer-assisted perfusion system technology. Results: Thirty-two (68%) patients underwent transcatheter septostomy for cardiac decompression. Diagnosis at presentation was either congenital heart disease (CHD, n = 15) or cardiomyopathy (n = 32). Ages ranged from 1 day to 22 years old (median, 18 months old), and weight ranged from 2.9 to 100 kg (median, 10 kg). The average duration of support was 242 hours (range, 22-1,078 hours). Overall long-term survival was 47%, with 16 (34%) patients successfully bridged to cardiac transplantation (of which 9 [56%] survived) and 13 (28%) successfully weaned from ECMO. Patients undergoing ECMO after cardiotomy had 31% survival. Survival was improved significantly (p < 0.02) in patients with cardiomyopathy (59%) vs those with CHD (20%). Patients with cardiomyopathy underwent 8 transplantations with 7 survivors (88%), whereas in the CHD group, there were 8 transplantations with only 2 survivors (25%), p < 0.05. Sub-analysis of the cardiomyopathy group revealed that patients with acute cardiomyopathy in association with documented viral illness had a 75% chance of being weaned from ECMO without undergoing transplantation. Complications during ECMO occurred in 45% of survivors and were more frequent in non-survivors. Infectious complications were most frequent, followed by neurologic complications, technical ECMO problems, and renal insufficiency. Conclusions: Patients with cardiomyopathy has a better prognosis than did those with CHD when using ECMO as a bridge to transplantation or survival. Complications are significant and increase with the duration of support. Extracorporeal membrane oxygenation for salvage and subsequent transplantation in this high-risk group of patients requires critical review. Alternative support options must be developed in the pediatric population that will allow improved outcomes, comparable with outcomes achieved in the adult population.

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