Successful Semi‐Ambulatory Veno‐Arterial Extracorporeal Membrane Oxygenation Bridge to Heart–Lung Transplantation in a Very Small Child. Issue 8 (14th April 2015)

• Record Type: Journal Article
• Authors: Wong, J. Y. W.; Buchholz, H.; Ryerson, L.; Conradi, A.; Adatia, I.; Dyck, J.; Rebeyka, I.; Lien, D.; Mullen, J.
• Is Part Of: American journal of transplantation. Volume 15:Issue 8(2015:Aug.)
• Page Start: 2256
• Page End: 2260
• Publication Date: 2015-04-14
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.13239
• Languages: English
• ISSNs: 1600-6135

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ajt13239-sec-0001" sec-type="section"> <p>Lung transplantation (LTx) may be denied for children on extracorporeal membrane oxygenation (ECMO) due to high risk of cerebral hemorrhage. Rarely has successful LTx been reported in children over 10 years of age receiving awake or ambulatory veno‐venous ECMO. LTx following support with ambulatory veno‐arterial ECMO (VA ECMO) in children has never been reported to our knowledge. We present the case of a 4‐year‐old, 12‐kg child with heritable pulmonary artery hypertension and refractory right ventricular failure. She was successfully bridged to heart–lung transplantation (HLTx) using ambulatory VA ECMO. Initial resuscitation with standard VA ECMO was converted to an ambulatory circuit using Berlin heart cannulae. She was extubated and ambulating around her bed while on VA ECMO for 40 days. She received an HLTx from an oversized marginal lung donor. Despite a cardiac arrest and Grade 3 primary graft dysfunction, she made a full recovery without neurological deficits. She achieved 104% force expiratory volume in 1 s 33 months post‐HLTx. Ambulatory VA ECMO may be a useful strategy to bridge very young children to LTx or HLTx. Patient tailored ECMO cannulation, minimization of hemorrhage, and thrombosis risks while on ECMO contributed to a successful HLTx in our patient.</p> </sec> </abstract>