Prolonged extracorporeal life support for bridging to transplant: technical and mechanical considerations

Through July 1995, the Extracorporeal Life Support Organization (ELSO) registry listed 87 patients who received extracorporeal life support (ECLS) as a bridge to cardiac transplantation with a survival rate of 41%. At Arkansas Children's Hospital, 17 patients (aged between two days and 24 years) with diagnoses of dilated cardiomyopathy (seven), postcardiotomy (seven) and acute viral myocarditis (three) were bridged with ECLS. Mechanical complications only occurred in two patients, neither of which necessitated withdrawal of ECLS. Decompression of the left heart was performed in 11 patients, six via a surgically placed vent and five with a blade/balloon atrial septostomy. Documented infection occurred in 11/17 patients, but only one patient died from infection. Fifteen of 17 patients (88%) recovered or were transplanted, of which 13 (76%) were discharged home. With left-heart decompression and appropriate treatment of infection, ECLS may be used as a bridge to cardiac transplantation or until the return of cardiac function.