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| Extracorporeal Membrane Oxygenation in Pediatric Lung Transplantation | |
Varun Puri1, Deirdre Epstein1, Steven C. Raithal1, Sanjiv K. Gandhi1, Stuart C. Sweet2, Albert Faro2, Charles B. Huddleston1; 1Division of Cardiothoracic Surgery, Washington University, St. Louis, St. Louis, MO; 2Department of Pediatrics, Washington University, St. Louis, St. Louis, MO
Methods: Review of an institutional database of pediatric LTx from 1990 to 2008. Results: Three hundred forty-two patients underwent LTx over the study period. Thirty-three of 342 (9.6%) patients required ECMO support in the perioperative period. Fifteen patients (mean age 2.7 ± 4.4 years) required 16 ECMO runs in the pretransplant period (PRE). Their diagnoses were; Pulmonary hypertension n=4, Surfactant deficiency n=3, Graft failure n=3, others n=4. The indications for ECMO were respiratory failure 8/16 (50%), severe pulmonary hypertension 5/16 (31%) and cardiopulmonary collapse 3/16 (19%). Vascular access was V-A (veno-arterial) (16/16, 100%) with neck vessels the preferred cannulation site (14/16, 87%). Mean duration of ECMO support was 226 ± 159 hours. All patients survived through LTx and 4/15 (27%) required ECMO support postoperatively. The mean time to LTx from institution of ECMO was 516 ± 631 hours and 6/15 (40%) patients were weaned off ECMO prior to LTx. Six of 15 (40%) PRE patients survived to hospital discharge. Complications (sepsis, reexploration and massive bleeding) were seen in 10/16 (63%) ECMO runs. Survival to discharge was higher in patients weaned off ECMO prior to LTx (4/6, 66%) than patients on ECMO going into LTx (2/9, 22%). All PRE patients requiring ECMO support postoperatively, or undergoing redo LTx died. Twenty-two patients (mean age 8.9 ± 7.5 years) underwent 24 ECMO runs after LtX (POST). Their diagnoses were; Cystic fibrosis n=6, Pulmonary hypertension n=5, Obliterative bronchiolitis n=4 and others n=7. The indications for ECMO support were; Primary graft dysfunction 16/24 (67%), pneumonia 4/24 (16%) and others 4/24 (16%). The mean time between LTx and institution of ECMO was 222 ± 312 hours. Access was predominantly V-A (23/24, 96%) and mean duration of ECMO support was 158 ± 125 hours. Four of 22 (18%) patients survived to hospital discharge (median survival 5.8 years). Amongst the non-survivors, the causes of death were intractable respiratory failure (13/18, 72%) and infectious complications (3/18, 17%). No specific risk factors were identified to predict poor outcomes in the POST group. Conclusion: The need for perioperative ECMO support is associated with significant morbidity and mortality in pediatric LTx. A subset of patients who can be weaned off ECMO in the preoperative setting have greater likelihood of survival. Back to 2009 Annual Meeting Back to Program Outline Back to Main Program |
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