Outcomes of Pediatric Patients Undergoing Cardiac Catheterization While on Extracorporeal Membrane Oxygenation

Abstract

The aim of the study is to explore the indications for cardiac catheterization while on extracorporeal membrane oxygenation (ECMO) and the various catheter interventions performed as well as assess the safety profile and determine the short- and intermediate-term survival. ECMO is a lifesaving intervention for pediatric patients with respiratory and/or cardiovascular failure. There is limited recent literature discussing the survival and outcomes of patients undergoing cardiac catheterization while on ECMO. A retrospective review of consecutive patients undergoing catheterization while on ECMO from 2004 to 2013 was performed. Thirty-six patients who underwent 40 cardiac catheterizations were identified. Indications for catheterization included hemodynamic/anatomic assessment of postoperative (16) and non-operative patients (7), planned catheter interventions (CI) (12), and cardiomyopathy assessment (5). CI were performed during 18 (45 %) catheterizations, including stenting of vessels/surgical shunts (9), balloon atrial septostomy (4), device closure of septal defects/vessels (3), thrombolysis of vessels (2), endomyocardial biopsy (2), and temporary pacer wire placement (1). Unexpected diagnostic information was found in 21 (52 %), and 13 patients were referred for surgical intervention. Successful decannulation was achieved in 86 % of patients. Survival to discharge was 72 % and intermediate survival was 69 % (median = 29 months). Survival was 88 % (15/17) among patients who underwent CI. There were six procedural complications (15 %); five vascular and one non-vascular. There were no complications related to patient transport. Cardiac catheterization and interventions while on ECMO are safe, with a survival to discharge of 72 %. Diagnostic information obtained from catheterization leads to management decisions which may impact survival.

Early Cardiac Catheterization Leads to Shortened Pediatric Extracorporeal Membrane Oxygenation Run Duration

“…These findings provide evidence that early detection and treatment of unsuspected residual lesions reduces ECLS duration and improves outcome. The diagnostic utility of echocardiography in post‐operative pediatric cardiac patients on ECLS has been called into question, as echocardiography has failed to detect 40–52% of lesions discovered at catheterization in previous studies . Our findings are in line with these data, as echocardiography failed to detect 39.6% of lesions found during catheterization in this series.…”

“…In a retrospective review of 36 pediatric cardiac patients, those receiving a catheterization on ECLS day 0 or day 1 had significantly shorter ECLS durations than patients receiving a catheterization 2 or more days after initiation of support (4 days vs. 7 days, P ¼ 0.0008). 3 However, no difference in survival was seen between groups. Another retrospective review of 75 catheterizations in pediatric ECLS patients found that the mean ECMO-to-catheterization time was shorter in survivors than non-survivors (1.6 vs. 3.5 days).…”

“…The impact of cardiac catheterization on ECLS outcomes is unclear. In a retrospective review of 36 pediatric cardiac patients, those receiving a catheterization on ECLS day 0 or day 1 had significantly shorter ECLS durations than patients receiving a catheterization 2 or more days after initiation of support (4 days vs. 7 days, P = 0.0008) . However, no difference in survival was seen between groups.…”

“…However, a minority of patients are unable to wean from extracorporeal support, many times without an obvious explanation. Despite a reluctance to perform invasive procedures on post‐operative cardiac patients on ECLS, cardiac catheterization has been shown to be safe in ECLS patients, with complication rates ranging from 3 to 15% . However, the effect of cardiac catheterization on ECLS‐related outcomes remains poorly defined.…”

“…4 Inadequacies in non-invasive testing, including echocardiography, have been documented when evaluating pediatric cardiac ECLS patients, with 1 report revealing unexpected diagnostic information found at catheterization in 52% of patients. 3 The aim of the present study was to evaluate the effect of an early cardiac catheterization strategy and its influence on ECLS outcomes.…”