Extracorporeal Membrane Oxygenation Use within 24 Hours of Heart Transplantation in Children: Incidence, Risk Factors, and Outcomes

Purpose Primary graft dysfunction following heart transplantation (HT) is associated with significant morbidity and mortality. The aim of this study was to assess the incidence, risk factors, and outcomes of pediatric patients requiring extracorporeal membrane oxygenation (ECMO) support post-HT. Methods This study utilized an existing data linkage between the PHIS and SRTR databases from which pediatric HT recipients were identified (2002-2016). Post-HT ECMO support was identified by billing codes within one day of HT. Logistic regression was performed to assess risk factors for ECMO post-HT. Kaplan-Meier analyses assessed in-hospital mortality and post-discharge survival. Results A total of 2,820 patients were included with 224 (7.9%) requiring ECMO post-HT. Risk factors independently associated with the need for ECMO included age Conclusion There are identifiable risk factors associated with the need for ECMO in the post-HT period. Length of time on ECMO post-HT is strongly associated with the risk of in-hospital mortality. While patients who require ECMO post-HT demonstrate worse overall survival, those who survive to discharge have comparable outcomes to patients who did not require ECMO.