Extracorporeal Membrane Oxygenation for Bridge to Heart Transplantation Among Children in the United States Analysis of Data From the Organ Procurement and Transplant Network and Extracorporeal Life Support Organization Registry
Extracorporeal Membrane Oxygenation for Bridge to Heart Transplantation Among Children in the United States Analysis of Data From the Organ Procurement and Transplant Network and Extracorporeal Life Support Organization Registry
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DOI：
10.1161/circulationaha.110.991505
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发表时间：
2011-06-28
期刊：
影响因子：
37.8
通讯作者：
Thiagarajan, Ravi R.
中科院分区：
文献类型：
--
作者：
Almond, Christopher S.;Singh, Tajinder P.;Thiagarajan, Ravi R.
背景-体外膜肺氧合（ECMO）已作为美国儿童的标准治疗超过20年，这些儿童需要机械支持作为心脏移植的桥梁。ECMO用于该适应症的安全性和有效性的客观数据有限。我们将ECMO的结果描述为心脏移植的桥梁，作为新兴的小型化辅助设备的性能基准，旨在取代ECMO.Methods和结果的数据，从体外生命支持组织登记处和器官采购移植网络数据库合并，以确定儿童支持ECMO和心脏移植从1994年至2009年上市。确定了等待名单和移植后住院死亡率的独立预测因素。制定了ECMO的客观性能目标。在773名儿童中，中位年龄为6个月（四分位距，1至44个月）; 28%患有心肌病; 38%在ECMO启动时预期为移植的桥梁。总体而言，45%的受试者达到了移植，尽管三分之一的移植者在出院前死亡;出院前的总生存率为47%。等待名单死亡率与先天性心脏病、ECMO前心肺复苏和肾功能不全独立相关。移植后死亡率与先天性心脏病、肾功能不全、ECMO持续时间>14天以及初始ECMO适应症作为恢复的桥梁相关。在客观性能目标队列（n=485）中，心肌病患者的出院存活率最高（63%），其次是心肌炎患者（59%）、2心室先天性心脏病患者（44%）和1心室先天性心脏病患者（33%）。对于等待心脏移植的儿童所需的长期循环支持是不可靠的。只有不到一半的ECMO桥接患者存活到出院。迫切需要更有效的方式为儿童的慢性循环支持。（循环。2011;123：2975-2984.）
Background-Extracorporeal membrane oxygenation (ECMO) has served for >2 decades as the standard of care for US children requiring mechanical support as a bridge to heart transplantation. Objective data on the safety and efficacy of ECMO for this indication are limited. We describe the outcomes of ECMO as a bridge to heart transplantation to serve as performance benchmarks for emerging miniaturized assist devices intended to replace ECMO.Methods and Results-Data from the Extracorporeal Life Support Organization Registry and the Organ Procurement Transplant Network database were merged to identify children supported with ECMO and listed for heart transplantation from 1994 to 2009. Independent predictors of wait-list and posttransplantation in-hospital mortality were identified. Objective performance goals for ECMO were developed. Of 773 children, the median age was 6 months (interquartile range, 1 to 44 months); 28% had cardiomyopathy; and in 38%, a bridge to transplantation was intended at ECMO initiation. Overall, 45% of subjects reached transplantation, although one third of those transplanted died before discharge; overall survival to hospital discharge was 47%. Wait-list mortality was independently associated with congenital heart disease, cardiopulmonary resuscitation before ECMO, and renal dysfunction. Posttransplantation mortality was associated with congenital heart disease, renal dysfunction, ECMO duration of >14 days, and initial ECMO indication as a bridge to recovery. In the objective performance goal cohort (n=485), patients with cardiomyopathy had the highest survival to hospital discharge (63%), followed by patients with myocarditis (59%), 2-ventricle congenital heart disease (44%) and 1-ventricle congenital heart disease (33%).Conclusion-Although ECMO is effective for short-term circulatory support, it is not reliable for the long-term circulatory support necessary for children awaiting heart transplantation. Fewer than half of patients bridged with ECMO survive to hospital discharge. More effective modalities for chronic circulatory support in children are urgently needed. (Circulation. 2011;123:2975-2984.)