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BMJ 2012; 345 doi: (Published 15 August 2012) Cite this as: BMJ 2012;345:e5450

Heart pumps improve children’s survival to transplantation

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Compared with adults, children with severe heart failure wait longer for a transplant. Also, fewer and less successful options are available, in terms of mechanical heart support, to prolong survival until a donor heart is available. Extracorporeal membrane oxygenation (ECMO) is most commonly used for this purpose, but previous research indicated that a ventricular assist device called the Berlin Heart Excor might offer additional survival benefit.

Direct comparison of the two approaches was considered unethical. Thus, propensity score matched registry data for children who previously received ECMO were used as a comparison. Even the primary outcomes differed: for Excor, this was time to death or weaning from the device owing to an unacceptable neurological outcome (coma or severe impairment after stroke); for ECMO, neurological outcomes were unavailable so only time to death was assessed.

Forty eight children 16 years or younger awaiting transplantation because of severe heart failure, despite state of the art medical treatment, were recruited in 17 centres across the US and Canada. All children were implanted with Excor devices. Among the 24 smaller children (body surface area <0.7 m2; median age 1 year), more than half were free of the primary outcome at 174 days—the longest any child was on the pump; 21 children underwent transplantation, whereas two children had died and one was taken off the pump because of severe stroke. In contrast, more than half of the smaller children who had received ECMO died by day 13. A similar survival benefit with Excor, compared with ECMO, was seen in larger children (body surface area 0.7-1.5 m2; median age 9 years).

However, serious adverse events such as major bleeding or infection occurred in about half of the children implanted with …

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