Stephens N Adam, Chartan Corey A, Gazzaneo Maria C, Thomas James A, Das Shailendra, Mallory George B, Melicoff Ernestina, Vogel Adam M, Parker Amanda, Hermes Emily, Heinle Jeffrey S, McKenzie E Dean, Coleman Ryan D
Section of Congenital Heart Surgery, Department of Surgery, Baylor College of Medicine, Houston, Tex.
Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Tex.
JTCVS Tech. 2023 Feb 10;18:111-120. doi: 10.1016/j.xjtc.2023.02.004. eCollection 2023 Apr.
Infants and young children awaiting lung transplantation present challenges that often preclude successful extracorporeal membrane oxygenation support as a bridge to transplantation. Instability of neck cannulas often results in the need for intubation, mechanical ventilation, and muscle relaxation creating a worse transplant candidate. With the use of Berlin Heart EXCOR cannulas (Berlin Heart, Inc) in both venoarterial and venovenous central cannulation configurations, 5 pediatric patients were successfully bridged to lung transplant.
We performed a single-center retrospective case review of central extracorporeal membrane oxygenation cannulation used as a bridge to lung transplantation cases performed at Texas Children's Hospital between 2019 and 2021.
Six patients, 2 with pulmonary veno-occlusive disease (15-month-old male and 8-month-old male), 1 with ABCA3 mutation (2-month-old female), 1 with surfactant protein B deficiency (2-month-old female), 1 with pulmonary arterial hypertension in the setting of D-transposition of the great arteries after repair as a neonate (13-year-old male), and 1 with cystic fibrosis and end-stage lung disease, were supported for a median of 56.3 days on extracorporeal membrane oxygenation while awaiting transplantation. All patients were extubated after initiation of extracorporeal membrane oxygenation, participating in rehabilitation until transplant. No complications due to central cannulation and use of the Berlin Heart EXCOR cannulas were observed. One patient with cystic fibrosis developed fungal mediastinitis and osteomyelitis resulting in discontinuation of mechanical support and death.
Novel use of Berlin Heart EXCOR cannulas for central cannulation eliminates the problem of cannula instability allowing extubation, rehabilitation, and bridge to lung transplant for infants and young children.
等待肺移植的婴幼儿面临诸多挑战，这些挑战常常使体外膜肺氧合（ECMO）支持难以成功作为移植桥梁。颈部插管的不稳定性常常导致需要插管、机械通气和肌肉松弛，从而使移植候选者情况更糟。通过在动静脉和静脉静脉中心插管配置中使用柏林心脏EXCOR插管（柏林心脏公司），5例儿科患者成功过渡到肺移植。
我们对2019年至2021年在德克萨斯儿童医院进行的将中心体外膜肺氧合插管用作肺移植桥梁的病例进行了单中心回顾性病例分析。
6例患者，2例患有肺静脉闭塞性疾病（15个月大男性和8个月大男性），1例患有ABCA3突变（2个月大女性），1例患有表面活性蛋白B缺乏症（2个月大女性），1例在新生儿期大动脉转位修复后出现肺动脉高压（13岁男性），1例患有囊性纤维化和终末期肺病，在等待移植期间接受体外膜肺氧合支持的中位时间为56.3天。所有患者在开始体外膜肺氧合后均拔除气管插管，在移植前参与康复治疗。未观察到因中心插管和使用柏林心脏EXCOR插管引起的并发症。1例患有囊性纤维化的患者发生真菌性纵隔炎和骨髓炎，导致机械支持中断并死亡。
将柏林心脏EXCOR插管用于中心插管的新方法消除了插管不稳定的问题，使婴幼儿能够拔除气管插管、进行康复治疗并过渡到肺移植。
