Deliberate bridging to transplantation in the paediatric age group: initial UK results

cc984 CCJ Meeting abstract Deliberate bridging to transplantation in the paediatric age group: initial UK results Smith JH Goldman A Macrae D Smith E Cassidy J Haynes SR Bolton DT Hamilton JRLH Hasan A De Leval M

The Freeman Hospital, Newcastle upon Tyne

Great Ormond Street Hospital

The Royal Brompton Hospital, London, UK

Critical Care Autumn Scientific Meeting of the Association of Cardiothoracic Anaesthetists Supported by an unrestricted educational grant from Bayer Biological Group Meeting abstracts Autumn Scientific Meeting of the Association of Cardiothoracic Anaesthetists Windermere, UK

3 November 2000

1364-8535 2001 5 Suppl A 7 http://ccforum.com/content/5/1/046 10.1186/cc984 4 1 2001 2000 BioMed Central Ltd on behalf of the copyright holder cc-5-1-046-7

Introduction

In the paediatric age group in the UK, there is an excess of donor organs over recipients. There are still deaths while waiting for transplantation. In an effort to extend the survival of children with dilated cardiomyopathy, we have employed a paracorporeal ventricular assist device (Medos HIA Assist, Medos, Stolberg, Germany) in patients who we felt were dying. We report our results here.

Method

We considered children who were admitted to our intensive care units (ICUs) with a diagnosis of dilated cardiomyopathy of such severity that they were ventilated. If listed for transplantation, they were considered for a mechanical assist device. Our threshold for this was the scenario detailed above, with the addition of incipient renal failure and escalation in the doses of the inotropes being used.

Results

The results are presented in Table 1.

Table 1

Patient characteristics, treatment details, complications and outcomes

Duration

Age

Weight

Blood

ICU

of assist

Vent.

Patient

(years)

(kg)

group

stay (days)

(days)

size

Transplant

Complications

Outcome

O⁺

3.5

Air embolus/bleeding

Death

6.5

O⁺

Yes

Bleeding/ventricle change/acute renal failure/complete heart block

Survive

2.5

B⁺

Yes

Ventricular clot

Survive

1.5

9.2

O^-

Yes

Colonic perforation/neuro/fungal sepsis/acute rejection

Death

13.6

53.3

O⁺

Yes

Bleeding/tamponade/re-exploration

Survive

24.4

A⁺

11.5

Yes

Bleeding/tamponade/jaundice/acute renal failure and PD

Survive

1.8

11.7

O^-

Neuro/bleeding/tamponade/seizures

Death

17.1

O⁺

Neuro/bleeding/tamponade/acute renal failure/multiorgan failure

Death

PD, peritoneal dialysis; neuro, neurological injury.

Conclusion

A bridge to transplantation is feasible. There are complications and 50% mortality. The criteria for support in this group need to be defined better. The benefit of such a costly programme alongside a transplant programme remains to be established.