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Study: New long-term circulatory support needed for children awaiting heart transplant

Almond CS. Circulation. 2011;123:2975-2984.

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Extracorporeal membrane oxygenation, the standard of care for children awaiting heart transplantation for more than 2 decades, was shown to be effective for short-term circulatory support but ineffective for long-term support.

Specifically, fewer than half of the children bridged with extracorporeal membrane oxygenation (ECMO) survived to hospital discharge.

“Our findings confirm what many have long suspected, that although ECMO is highly effective for short-term circulatory support, it is not capable of providing the kind of reliable long-term circulatory support necessary for bridging children safely to heart transplantation,” the researchers wrote. “With just one of every two patients bridged with ECMO surviving to hospital discharge, our findings underscore why children awaiting heart transplantation have faced the single highest wait-list mortality in solid-organ transplant medicine and emphasize the urgency behind the NHLBI’s initiative to develop more reliable miniaturized assist devices for the smallest patients.”

The study involved children (n=773; median age, 6 months) who were supported with ECMO and listed for heart transplantation in the Extracorporeal Life Support Organization Registry and the Organ Procurement Transplantation Network database between 1994 and 2009.

Of these children, 45% survived to transplantation; 28% died while on the waiting list; 11% were removed from the list due to clinical deterioration; 10% were removed because of recovery; and 6% were alive and on the waiting list on the last day of the study.

In all, researchers reported that survival to hospital discharge was 47%. CHD, renal dysfunction and cardiopulmonary resuscitation before ECMO proved to be independent predictors of wait-list mortality, whereas CHD, renal dysfunction, initial ECMO indication as a bridge to recovery and ECMO duration of more than 14 days independently predicted post-transplantation mortality.

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