(From the November 2013 Issue of PediatricsOnline)
Children with advanced lung disease who need a transplant have limited options. Only eight children’s hospitals in the U.S. perform the procedure, and moving patients long distances to one of these programs is often risky. Nationwide Children’s Hospital performed the first successful cross-country transport of a pediatric patient for lung transplant, as reported recently in the journal Pediatric Transplantation.
Nationwide Children’s is among the handful of children’s hospitals certified by the United Network for Organ Sharing to do pediatric lung transplants that also has a multidisciplinary team created to manage the care of patients during transfer from institutions that don’t perform the delicate procedure. In the fall of 2012, the transport team, consisting of a critical care physician, nurse and a cardiovascular perfusionist, flew a 13-year-old with advanced interstitial lung disease from Phoenix Children’s Hospital to Nationwide Children’s.
During the flight, the transport team used a mechanical device called a single-site venovenous extracorporeal membrane oxygenation (VV ECMO) to provide respiratory support. Unlike the standard ECMO support, the portable ECMO does not require sedation or paralytics. With VV ECMO, patients awaiting transplant at Nationwide Children’s can eat normally and participate in physical therapy, building their strength as they prepare for surgery. Three weeks after the patient’s arrival, she received a bilateral lung transplant. She was discharged a month after the surgery, eventually returning to her home in Phoenix with Nationwide Children’s coordinating her care through the local adult lung transplant program. The patient has since started high school and is doing very well.
This portable ECMO has been used in the past as a “bridge” to lung transplantation in adults, but because so few institutions perform these transplants in pediatric patients, it hasn’t been widely used in children. To our knowledge, Nationwide Children’s is the first free-standing children’s hospital to use the device to transport a pediatric patient, says Don Hayes Jr., MD, medical director of the Advanced Lung Disease Program and the Lung and Heart-Lung Transplant Programs at Nationwide Children’s Hospital and The Ohio State University.
“It’s the vision of the administration at Nationwide Children’s Hospital and the Advanced Lung Disease Program to provide this innovative care to children nationally and even internationally,” Dr. Hayes says. “This sophisticated care has been widely available for adult patients needing lung transplantation, but not for children. It is no surprise that, with the expertise in pulmonary medicine, ECMO and lung transplantation at Nationwide Children’s Hospital, we have rapidly developed a program that is quickly becoming a leader in pediatric medicine.”
Hayes D Jr, Galantowicz M, Preston TJ, Tellez D, McConnell PI, Yates AR, Dalton HJ. Cross-country transfer between two children's hospitals of a child using ambulatory extracorporeal membrane oxygenation for bridge to lung transplant. Pediatric Transplantion. 2013;17(5):E117-8.