Emergent use of extracorporeal membrane oxygenation during pediatric cardiac catheterization.
OBJECTIVE
The goal of this study was to evaluate the utility of extracorporeal membrane oxygenation (ECMO) to resuscitate patients following critical cardiac events in the catheterization laboratory.


METHODS
Retrospective review of medical records.


METHODS
Cardiac intensive care unit and cardiac catheterization laboratory at a tertiary care children's hospital.


METHODS
Pediatric patients cannulated emergently for ECMO in the cardiac catheterization laboratory (n = 22).


METHODS
ECMO was initiated emergently in the cardiac catheterization laboratory for progressive hemodynamic deterioration due to low cardiac output syndrome or catheter-induced complications.


RESULTS
Twenty-two patients were cannulated for ECMO in the catheterization laboratory between 1996 and 2004. Median age was 33 months (range 0-192), median weight 14.8 kg (2.4-75), and median duration of ECMO 84 hrs (2-343). Indications included catheter-induced complication (n = 14), severe low cardiac output syndrome (n = 7), and hypoxemia (n = 1). Three patients (14%) were cannulated in the catheterization laboratory before catheterization for low cardiac output or hypoxemia. During cannulation, 19 patients (86%) were receiving chest compressions; median duration of cardiopulmonary resuscitation was 29 mins (20-57). Eighteen patients (82%) survived to discharge (five of whom underwent cardiac transplantation) and four (18%) died. Of 19 patients who received cardiopulmonary resuscitation during cannulation, 15 (79%) survived to discharge and nine (47%) sustained neurologic injury. There was no significant difference between survivors and nonsurvivors in age, weight, duration of cardiopulmonary resuscitation or ECMO support, pH, or lactate levels.


CONCLUSIONS
ECMO is a technically feasible and highly successful tool in the resuscitation of pediatric patients following critical events in the cardiac catheterization laboratory.
Allan
Catherine K
CK
Department of Cardiology, Children's Hospital, Boston and Harvard Medical School, Boston, MA.
Thiagarajan
Ravi R
RR
Armsby
Laurie R
LR
del Nido
Pedro J
PJ
Laussen
Peter C
PC
D000293:Adolescent; D006328:Cardiac Catheterization / Q000009:adverse effects*; D002303:Cardiac Output, Low / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D004630:Emergencies; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome