EXTRACORPOREAL MEMBRANE-OXYGENATION AS A BRIDGE TO CARDIAC TRANSPLANTATION IN CHILDREN

The feasibility and efficacy of extracorporeal membrane oxygenation (E CMO) as a bridge to cardiac transplantation was examined in 6 pediatri c patients who suffered irreversible myocardial failure after undergoi ng surgery for congenital heart defects. The mean time of ECMO support was 260.5 h, range, 101-102 h. Three patients underwent transplantati on, 2 of whom are longterm survivors. Progressive hypotension as a res ult of capillary leak syndrome precluded further ECMO support in the o ther 3 patients. Overall, 2 of the 6 patients survived. Major complica tions were encountered in 4 patients including bleeding in 2, a seizur e in 1, and renal failure in 3, 2 of whom recovered renal function aft er transplantation. Infection did not occur in any of the 6 patients. Exchanging ECMO components was performed with no difficulties; these e xchanges included a centrifugal pump once for 2 patients and a membran e oxygenator once for 3 patients. Our results indicate that ECMO can s afely keep critically ill pediatric transplant candidates alive for mo re than 1 week with a low incidence of multiple organ failure.