Pediatric Extracorporeal Membrane Oxygenation in Restrictive and Hypertrophic Cardiomyopathy: A Single Center Experience

体外膜肺氧合 医学 肥厚性心肌病 四分位间距 心脏病学 人口 心肺复苏术 心室辅助装置 内科学 心肌病 单中心 心力衰竭 外科 复苏 环境卫生
作者
Diana L. Geisser,Bryan D. Siegel,Ryan Kobayashi,Christina VanderPluym,Francis Fynn‐Thompson,Ravi R. Thiagarajan,Katie M. Moynihan
出处
期刊:Asaio Journal [Ovid Technologies (Wolters Kluwer)]
标识
DOI:10.1097/mat.0000000000002322
摘要

Patients with restrictive cardiomyopathy (RCM) and hypertrophic cardiomyopathy (HCM) were previously considered poor candidates for mechanical circulatory support due to technical limitations related to restrictive ventricular physiology and small ventricular size, limiting the ability to provide adequate flows and decompress the heart. Literature examining use of extracorporeal membrane oxygenation (ECMO) in this population consists of a single case series reporting no survivors. We report our experience providing ECMO in children with RCM or HCM at a large pediatric quaternary cardiac center. Between 2012 and 2022, five patients (four RCM, one HCM) were supported with seven ECMO runs. All patients were cannulated to ECMO with ongoing cardiopulmonary resuscitation. Four patients survived decannulation from ECMO (median support time 209 hr, interquartile range [IQR]: 48–265), of which three (60%) survived to hospital discharge after transitioning to a ventricular assist device (VAD) and undergoing orthotopic heart transplant (OHT). Two remain alive at long-term follow-up with normal or mildly impaired functional status. These findings suggest that while RCM and HCM have traditionally been considered contraindications to ECMO due to adverse outcomes, this population may be successfully supported with ECMO with survival comparable to international registry outcomes in select centers where VAD as a bridge to OHT is available.
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