USE OF ECMO IN THORACIC ORGAN TRANSPLANTATION:

64 We reviewed the use of ECMO support in the management of patients listed for or receiving heart (H), lung (L) or heart/lung (H/L) transplantation at CHOP from November 1994 to June 1997. During this period 117 patients were listed for organ transplantation: H-52, L-48, and H/L-17. A total of 51 (44%) patients were transplanted: H-27, L-19, H/L-5. Hospital survival over the thirty-one months of the study was: H (88%), L (91%) and H/L (100%). Twelve month actuarial survival was: H (77%), L (79%), and H/L (68%). A total of twenty-two patients were placed on ECMO before (16) or after (6) transplant: H-11/52 patients (21%); L-8/48 patients (17%); H/L-3/17 patients (17.5%). This was 44% of all patients placed on ECMO in the CICU and 19% of all patients listed for thoracic organ transplant. Average time on ECMO was 301 hours, (min. = 46; max. = 1149 hrs), with no difference in time based on survival, listed organ, weight or age. Survival to transplant on ECMO differed in H-transplant patients (9/11), 82%, vs. L (1/8), 13%, or H/L (0/3), 0% patients and was predicted by the absence of pulmonary hypertension. Only one of eight patients with pulmonary hypertension, placed on ECMO, survived to transplant. Further, in patients placed on ECMO precipitated by cardiac arrest, survival to transplant was 5/6 in patients without pulmonary hypertension and 0/4 in patients with pulmonary hypertension (P=0.03). In the latter group, all 4 suffered severe neurologic injury despite rapid restoration of adequate systemic perfusion leading to discontinuation of support. Overall hospital survival was (9/15) 60% in patients without pulmonary hypertension and (8/11) 73% in H-transplant patients. We conclude that ECMO is an effective adjunctive therapy in patients without pulmonary hypertension, listed for thoracic organ transplant, even after cardiac arrest.