Galantowicz M E, Stolar C J
Babies Hospital, Columbia-Presbyterian Medical Center, New York, N.Y. 10032.
J Thorac Cardiovasc Surg. 1991 Jul;102(1):148-51; discussion 151-2.
Extracorporeal membrane oxygenation has demonstrated effectiveness for cardiopulmonary support in a variety of clinical situations. This article reviews the cases in which extracorporeal membrane oxygenation was used as an adjunct to pediatric cardiac transplantation. Twenty children, aged 7 days to 17 years, with cardiac failure refractory to conventional therapy received extracorporeal membrane oxygenation for 6 to 192 hours. In 4 cases it was used as a bridge to transplantation; in 10 cases it facilitated resuscitation of the cardiac allograft in the immediate postoperative period; and in 6 cases it complemented therapy for severe rejection in the late postoperative period. Twelve patients survived extracorporeal membrane oxygenation, 7 of whom lived more than 8 months. One long-term survivor was in the bridge-to-transplant group, 4 in the immediate postoperative group, and 2 in the rejection group. All survivors have normal cardiac allograft function. These data suggest that extracorporeal membrane oxygenation can be used to support profound cardiac failure in the pediatric heart transplant patient as a bridge to transplantation, in the resuscitation of the cardiac allograft, or to supplement a rejecting allograft.
体外膜肺氧合已在多种临床情况下证明对心肺支持有效。本文回顾了将体外膜肺氧合用作小儿心脏移植辅助手段的病例。20名年龄在7天至17岁之间、常规治疗难治性心力衰竭的儿童接受了6至192小时的体外膜肺氧合。其中4例用作移植桥梁；10例在术后即刻促进心脏同种异体移植的复苏；6例在术后晚期补充严重排斥反应的治疗。12例患者在体外膜肺氧合后存活，其中7例存活超过8个月。1例长期存活者在移植桥梁组，4例在术后即刻组，2例在排斥反应组。所有存活者的心脏同种异体移植功能均正常。这些数据表明，体外膜肺氧合可用于支持小儿心脏移植患者严重心力衰竭，作为移植桥梁、心脏同种异体移植的复苏手段或补充排斥的同种异体移植。
