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Prolonged extracorporeal life support for bridging to transplant: technical and mechanical considerations
E A Frazier1, S C Faulkner, P M Seib
1Department of Pediatric Cardiology, Arkansas Children's Hospital, Little Rock 72202-3591, USA.
Insights
Extracorporeal life support (ECLS) can be a successful bridge to cardiac transplantation for pediatric patients. This method demonstrated an 88% recovery or transplant rate, with 76% of patients discharged home.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Extracorporeal Life Support Organization (ELSO) registry data shows a 41% survival rate for extracorporeal life support (ECLS) as a bridge to cardiac transplantation.
- Pediatric patients with severe heart conditions often require advanced support to improve outcomes.
Purpose of the Study:
- To evaluate the efficacy and safety of ECLS as a bridge to cardiac transplantation in pediatric patients.
- To assess the impact of left-heart decompression and infection management on ECLS outcomes.
Main Methods:
- Retrospective analysis of 17 pediatric patients treated with ECLS at Arkansas Children's Hospital.
- Patients diagnosed with dilated cardiomyopathy, postcardiotomy, or acute viral myocarditis were included.
- Left-heart decompression strategies and infection management protocols were documented.
Main Results:
- 17 pediatric patients (2 days to 24 years) received ECLS.
- Mechanical complications were minimal (2/17), and only one patient died from infection.
- Fifteen of 17 patients (88%) were successfully bridged to recovery or cardiac transplantation, with 13 (76%) discharged home.
Conclusions:
- ECLS is a viable and effective bridge to cardiac transplantation in pediatric patients.
- Left-heart decompression and prompt infection treatment are crucial for improving ECLS outcomes.
- ECLS can serve as a bridge to transplantation or support until native cardiac function returns.
Abstract:
Through July 1995, the Extracorporeal Life Support Organization (ELSO) registry listed 87 patients who received extracorporeal life support (ECLS) as a bridge to cardiac transplantation with a survival rate of 41%. At Arkansas Children's Hospital, 17 patients (aged between two days and 24 years) with diagnoses of dilated cardiomyopathy (seven), postcardiotomy (seven) and acute viral myocarditis (three) were bridged with ECLS. Mechanical complications only occurred in two patients, neither of which necessitated withdrawal of ECLS. Decompression of the left heart was performed in 11 patients, six via a surgically placed vent and five with a blade/balloon artial septostomy. Documented infection occurred in 11/17 patients, but only one patient died from infection. Fifteen of 17 patients (88%) recovered or were transplanted, of which 13 (76%) were discharged home. With left-heart decompression and appropriate treatment of infection, ECLS may be used as a bridge to cardiac transplantation or until the return of cardiac function.
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