title: Early catheterization after initiation of extracorporeal membrane oxygenation support in children is associated with improved survival.
abstract: OBJECTIVE
  The study evaluated the institutional experience with cardiac catheterization on extracorporeal membrane oxygenation (ECMO) support.
  
  
  BACKGROUND
  There is scant literature on the outcomes of catheterization on ECMO.
  
  
  METHODS
  A retrospective review was performed of all children who underwent catheterization on ECMO from 2003 to 2013. Patients were categorized as cardiomyopathy (CM) or congenital heart disease (CHD).
  
  
  RESULTS
  During the study period, 215 children were placed on cardiac ECMO. Of these, 29.8% underwent 75 catheterization procedures while on ECMO support. The median age of the cohort was 1.5 months (range 0 days -16.7 years) and the median weight was 3.9 kg (2.2-63.1 kg). CM patients constituted 18.8% of the cohort and all of them underwent atrial septoplasty (an atrial septal stent in 7/12 and balloon atrial septoplasty or septostomy in 5). The survival to hospital discharge rate was 83% and the transplant-free survival rate was 58.3%. CHD patients constituted 81.2% of the cohort. In this group, transcatheter interventions were performed in 40.4% and subsequent surgical interventions in 40.4%. Survival to hospital discharge rate was 34.6% and transplant free survival rate was 32.7%. Overall, 76.7% underwent transcatheter or surgical interventions. The major catheterization complication rate was 6.7%. The mean ECMO-to-catheterization time was 1.6 days for survivors and 3.5 days for non-survivors (P = 0.034). Survival to discharge was better for the CM group compared to the CHD group (P = 0.01). Among CHD, survival was better with transcatheter interventions compared to no interventions or surgical interventions (P < 0.001).
  
  
  CONCLUSIONS
  Cardiac catheterization and transcatheter interventions on ECMO can be performed with low rate of complications. Catheterization was associated with high rate of interventions. Better survival to hospital discharge was associated with transcatheter interventions, earlier performance of catheterization after ECMO and diagnosis of CM. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Boban P
authors.initials: BP
authors.lastname: Abraham
authors.affiliation: Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Erikka
authors.initials: E
authors.lastname: Gilliam
authors.affiliation: Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Dennis W
authors.initials: DW
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Wolf
authors.affiliation: Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Vincent
authors.affiliation: Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia. cjpetit@emory.edu.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Petit
mesh_terms: D000293:Adolescent; D000367:Age Factors; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000401:mortality; D009202:Cardiomyopathies / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005845:Georgia; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016027:Heart Transplantation; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D010351:Patient Discharge; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: mechanical life support; pediatric; transcatheter intervention