Extracorporeal Membrane Oxygenation for Perioperative Support in Neonatal and Pediatric Cardiac Transplantation Andrew O. Hopper, Janie Pageau, Leela Job, Joya Heart, Douglas D. Deming, and Ricardo L. Peverini Division of Neonatology, Department of Pediatrics, Loma Linda University School of Medicine, and Loma Linda University Children’s Hospital ECMO Program, Loma Linda, California, U.S.A. Abstract: Currently there is a lack of consensus on guide- lines in the clinical application of extracorporeal mem- brane oxygenation (ECMO) in neonatal and pediatric car- diac transplantation patients. In this context, given the limited data presently available through the Extracorpo- real Life Support Organization (ELSO) Registry, we con- ducted a preliminary survey to specifically evaluate the practice of using ECMO as a bridge to cardiac transplan- tation or as posttransplantation therapy for failure to wean from cardiopulmonary bypass or graft failure. We received responses to our questionnaire from 95 of 118 (81%) cen- ters located in the U.S.A. and abroad. Of the 95 centers that responded, 36 were performing neonatal/pediatric cardiac transplants, with 29 centers reporting the concomi- tant use of ECMO to support cardiac transplant patients. There was wide variability in the responses from the 29 centers to a selected list of relative ECMO contraindica- tions. However, only 7 centers had specific ECMO entry criteria for cardiac transplant patients. Fifteen of the 29 centers provided relevant data on cardiac transplant pa- tients including the proportions of neonatal (11 of 37) and pediatric (63 of 217) patients requiring ECMO; neonatal (2 of 5) and pediatric (16 of 27) patients surviving to trans- plant; and neonatal (1 of 5) and pediatric (12 of 27) pa- tients surviving to hospital discharge. These findings con- firm the important role of ECMO in providing perioperative support in neonatal and pediatric cardiac transplantation patients. However, the lack of consensus among centers contributes to uncertainty in the decision making process to offer ECMO and to utilize ECMO ef- fectively in this high risk population. We recommend that institution-specific information be collected, either using the ELSO Registry (or by a similar multicentric database) to develop specific guidelines for ECMO applications in cardiac transplant patients, and to carefully monitor and follow up EMCO treated patients to further evaluate the efficacy of this limited resource. Key Words: Extracor- poreal membrane oxygenation—Cardiac transplantation. The use of extracorporeal membrane oxygenation (ECMO) is increasingly being considered as an op- tion to support intractable cardiac failure either as a bridge to cardiac transplantation or as a postopera- tive therapy for graft failure. According to the Ex- tracorporeal Life Support Organization (ELSO) Registry (Ann Arbor, MI, U.S.A.), the survival to hospital discharge rate in children requiring ECMO for bridge to transplantation is 48% (1). While several recent reports have suggested im- proved survival in pediatric cardiac transplant pa- tients receiving extended ECMO support, overall survival has not changed significantly, in part due to complications that may develop while on ECMO that could potentially preclude transplantation (2–4). There is debate regarding the usage of ECMO in patients with severe graft rejection when it is unclear whether the underlying cardiac condition is revers- ible. There have also been reservations about the perioperative use of ECMO given the uncertainty of the duration of the ECMO run, a concern exacer- bated by growing donor cardiac graft shortages. Although the ELSO Registry lists broad guide- lines for initiation of cardiac ECMO, there is little information regarding specific ECMO entry criteria that may be employed in these patients. The objec- tive of this report is to describe areas of common practice in the use of ECMO for perioperative sup- Received March 1999. Presented in part at the International Conference on Pediatric Cardiac ECMO in Vienna, October 1–3, 1998. Address correspondence and reprint requests to Dr. Andrew O. Hopper, Department of Pediatrics, Loma Linda University, School of Medicine, 11175 Campus St., Loma Linda, California 92354, U.S.A. Artificial Organs 23(11):1006–1009, Blackwell Science, Inc. © 1999 International Society for Artificial Organs 1006