Extracorporeal oxygen only suitable short-term in children awaiting heart transplant
MedWire News: Extracorporeal membrane oxygenation (ECMO) is effective for short-term circulatory support required by children awaiting heart transplantation, but unreliable in the longer term, research indicates.
Christopher Almond (Children's Hospital Boston, Massachusetts, USA) and colleagues set out to describe the safety and efficacy profile of ECMO as a bridge to heart transplantation in children, and to develop performance goals for the technique.
The researchers merged data from the Extracorporeal Life Support Organization Registry and the Organ Procurement Transplant Network database, to identify children supported with ECMO and listed for heart transplantation from 1994 to 2009. The final study population comprised 773 children with a median age of 6 months.
The findings, reported in the journal Circulation, reveal that 28% of patients had cardiomyopathy, 38% of whom had a bridge to transplantation intended at ECMO initiation. Overall, 45% of patients reached transplantation, but one-third died before discharge.
The overall rate of survival to hospital discharge in ECMO patents was 47%.
Waiting-list mortality was independently associated with one-ventricle and two-ventricle lesion congenital heart disease (p=0.002 and p=0.02, respectively), cardiopulmonary resuscitation (CPR) before ECMO (p=0.02), and renal dysfunction, defined by creatinine clearance below 20 ml/min/1.73 m2 (p=0.001).
Post-transplantation mortality was associated with one-ventricle and two-ventricle lesion congenital heart disease (p<0.001 and p=0.02, respectively), renal dysfunction (p<0.001), and ECMO duration of more than 14 days (p<0.001).
The researchers also analyzed a secondary cohort of 485 patients, which led them to propose new performance criteria for ECMO, including efficacy of bridge to transplantation, survival to discharge proportion, and safety as variables.
Almond et al conclude: "The objective performance estimates for ECMO described may be useful as clinical benchmarks for emerging mechanical circulatory support devices likely to supersede ECMO in the new era of pediatric mechanical support."
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By Piriya Mahendra