Extracorporeal Membrane Oxygenation in Primary Graft Failure After Heart Transplantation

Usefulness of extracorporeal membrane oxygenation for early cardiac allograft dysfunction

“…17 In our cohort, we demonstrated a 7-day survival rate of 94% and survival to discharge of 82.4%. This is similar to data from another large Australian transplant unit of 94.9% and 74.3%, respectively, 18 and significantly higher than other reports (approximately 50%) where ECMO is used solely for acute non-specific graft dysfunction. 19,20 In our institution, where ECMO is planned in the setting of abnormal pre-transplant donor LV function, pre-discharge LV function returned to normal before discharge, which supports the consideration of that group of marginal donors in the absence of other contraindications.…”

“…Patients who receive a heart from an extended criteria donor, such as preceding impaired LV function, 21 prolonged ischemic time, 18,21 and older donors, 22 may benefit from planned ECMO after the transplant. We have confirmed that patients with normal pre-transplant donor function, who require ECMO to come off CPB due to prolonged ischemic times, are also able to be supported with ECMO until the acute graft dysfunction improves, with satisfactory outcomes.…”

Long-term survival of adults with cardiogenic shock after venoarterial extracorporeal membrane oxygenation

“…To date, the factors identified as associated with worse longer term outcomes after VA ECMO have included age and diabetes [4,6,23,24], elevated INR, chronic renal function [6,8,11,22,25], chronic obstructive pulmonary disease [8,11,23,26], duration of ECMO [6,24,25], and Sequential Organ Failure Assessment Score [8,11,24,25,[27][28][29][30]. This suggests that both the degree of acute physiologic derangement and the burden of chronic disease are important in determining the longer term outcome after VA ECMO.…”

Position article for the use of extracorporeal life support in adult patients

“…Typical clinical scenarios are [6][7][8][9]: postcardiotomy cardiac failure, acute exacerbation of chronic severe heart failure, acute heart failure due to drug intoxication, acute heart failure due to myocardial infarction, hypothermia, acute circulatory failure due to intractable arrhythmias, and cardiac arrest requiring cardiopulmonary resuscitation (CPR) in clinical situations described above.…”