Heart transplant recipients supported with extracorporeal membrane oxygenation: outcomes from a single-center experience.

BACKGROUND

Extracorporeal membrane oxygenation (ECMO) provides hemodynamic support in refractory cardiogenic shock and may be used after heart transplantation for primary graft dysfunction or rejection. We hypothesized that survival after ECMO support is contingent upon patient selection.

METHODS

We examined consecutive adult heart transplant recipients at a single center who underwent transplantation between 1997 and 2009 and required ECMO support. Patients were divided by clinical presentation: pre-emptive therapy, escalating inotropic requirements despite support by intra-aortic balloon pump (IABP); and salvage therapy, cardiac arrest undergoing cardiopulmonary resuscitation with chest compressions.

RESULTS

Between 1997 and 2009, there were 37 instances of ECMO use in 32 patients: 23 episodes (19 patients) for pre-emptive therapy and 14 episodes (14 patients) for salvage therapy; 1 patient had both pre-emptive and salvage therapy. Patients did not differ in age, gender or ischemic time. ECMO support was for a median 6 days in both groups, and the incidence of serious vascular complications was comparable (35% and 36%). In the pre-emptive therapy group, 15 episodes (79%) were associated with survival to hospital discharge and 5 patients (26%) were alive at 1 year. In the salvage therapy group, 2 episodes (14%) were associated with survival to hospital discharge and 1 patient (7%) was alive at 1 year.

CONCLUSIONS

ECMO support is a viable option for adult heart transplant recipients with severe rejection and refractory cardiogenic shock. To maximize the benefit of this aggressive approach in heart transplant recipients requires early intervention, with a heightened awareness of this option to facilitate expedited use.