Utility of extracorporeal membrane oxygenation for early graft failure following heart transplantation in infancy

Background: Extracorporeal membrane oxygenation (ECMO) is widely used for p ostcardiotomy cardiogenic shock in children. However, the efficacy of ECMO for early post-heart transplant graft failure in infants has not been repor ted. Our aims were to determine: (1) the utility of ECMO in infants with se vere donor-heart dysfunction, (2) predictors for requiring ECMO, and (3) th e long-term outcome of surviving ECMO patients. Methods: All infants (age < 6 months at listing) undergoing heart transplan tation were reviewed. Diagnostic categories were hypoplastic left heart syn drome (HLHS) and non-HLHS (complex congenital heart disease and cardiomyopa thies). Continuous and categorical comparisons were by Wilcoxon's rank sum test and Fisher's exact test respectively. Results: 14 (12 HLHS, 2 non-HLHS) of 63 (46 HLHS, 17 non-HLHS) infants were placed on ECMO. Ten patients (71%) were successfully weaned from ECMO and 8 (57%) were discharged alive. All ECMO hospital survivors remain alive (me an followup 36.2 +/- 21.4 months, range 13.1-77.6 months). Mean duration of ECMO support was 68 hours in weaned patients vs 144 hours (p = 0.19) in no nweaned patients, and 64 hours in survivors vs 123 hours (p = 0.35) in nons urvivors. ECMO deaths were due to sepsis (n = 3), intractable pulmonary hyp ertension (n = 2), and intracranial bleed (n : 1). Neurologic deficits occu rred in 2 survivors. Median ICU and hospital stays for ECMO survivors were 29 and 33 days vs 7 (p = 0.0003) and 9 (p = 0.0004) days for non-ECMO patie nts. Age listed, age transplanted, wait time, body weight, donor/recipient weight ratio, total ischemia time, and diagnosis did not predict the need f or ECMO. Conclusions: (1) ECMO is useful for post-heart transplant circulatory suppo rt in infants with early graft failure. (2) All survivors were weaned in fe wer than 4 days. (3) Three-year survival of ECMO hospital survivors has bee n high, but neurologic complications are prevalent.