摘要: Objective To review the efficacy and clinical outcomes of extracorporeal membrane oxygenation(ECMO)used for donor hearts with long cold ischemic times (LCIT) during heart transplantation.Methods From February 2005 to April 2009,11 patients were received allografts with LCIT over 7 hours underwent both intraoperative ECMO circuit treatment and ECMO support postoperation (i-ECMO group).Another 11 patients with ischemia time of heart grafts less than seven hours were received postoperation ECMO support as a salvage therapy after perioperative standard cardiopulmonary bypass CPB(s-CPB group).Rate of weaning ECMO,length of ICU stay,volume of packed red blood cell (PRBC) transfusion,left ventricular ejection fraction (LVEF),cost of hospitalization,rate of perioperative survival and rate of 1-year postoperative survival were compared between the two groups.ECMO-related complications were observed.Results There was a significant difference in cold ischemic time between the two groups (P<0.01),with cold ischemic time ranging from 422 to 485 minutes (mean 448 minutes) in i-ECMO group while 110 to 400 minutes (mean 218 minutes) in s-CPB group.Ten patients (91%) in i-ECMO group were weaned off ECMO and all survived to discharge.Only a patient in this group died of massive intraoperative bleeding (not ECMO-related).Rate of weaning ECMO in the s-CPB group was 82% (9/11).The overall weaning rate of ECMO application during heart transplantation was 86%.The overall 30-day and 1-year survival rates for i-ECMO and s-CPB groups were 91% and 82%,73% and 64%,respectively.There was no difference in mortality between the two groups (P>0.05).Compared with s-CPB group,the length of stay in ICU,the requirement for PRBC administration and the total in-hospital cost were significantly reduced in the i-ECMO group (P<0.05).The preoperative and postoperative LVEF of i-ECMO and s-CPB groups were 0.23±0.06 and 0.25±0.10,0.65±0.12 and 0.66±0.06,respectively.LVEF of both groups significantly improved after operation.An intra-aortic balloon pump (IABP) was applied due to low cardiac output in 5 patients (23%),among them 3 patients weaned from ECMO except another two patients.Among 6 patients (27%) who required continuous renal repacement therapy (CRRT ) due to renal dysfunction,2 were weaned from ECMO and 4 could not be weaned.Conclusions Application of ECMO in postoperative period provides early,continued and effective support for donor hearts with LCIT and efficiently makes use of such marginal organs.Reduced length of ICU stay,reduced transfusion volume of PRBC and reduced in-hospital cost are additional advantages of this technique.