title: Impacts of early cardiac catheterization for children with congenital heart disease supported by extracorporeal membrane oxygenation.
abstract: BACKGROUND
  Cardiac catheterization is often required for patients on extracorporeal membranous oxygenation (ECMO) support, though its efficacy remains unclear. This study aimed to assess the impact of catheterization on successful ECMO weaning.
  
  
  METHODS
  This is a single-center retrospective study from 2000 to 2014. Patients with congenital heart disease who underwent cardiac catheterization while on cardiac ECMO support were included. Logistic regression analysis and Kaplan-Meier survival analysis with log-rank test were performed to determine predictors for successful weaning and patient outcome.
  
  
  RESULTS
  Forty-nine catheterizations in 47 patients with the median age of 65 days (range: 1 day-12 years) and the median body weight of 4.2 kg (range: 1.9-32.7 kg) were included. Median duration between ECMO cannulation and catheterization was 1 day (range: 0-11 days). Thirty-three patients (70%) succeeded in decannulation and 24 patients (51%) survived to hospital discharge. Absence of renal (P = 0.045) and respiratory complications (P = 0.031) were significant prognostic factors for successful weaning in multivariate analysis. Patients who received catheterization within 48 hr after ECMO cannulation demonstrated less respiratory complications (P = 0.006) and better survival at 30 days after ECMO initiation (P = 0.039) than those who underwent later catheterization. There was no mortality; however, nine major catheterization-related complications (18%) were detected.
  
  
  CONCLUSIONS
  Catheterization for pediatric patients on ECMO support can be performed, although this group contained high risk of serious adverse events. The absence of ECMO complications is a predictor for successful weaning. An earlier catheterization appears to be associated with better short-term survival in this cohort. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Divisions of Cardiology, The Labatt Family Heart Centre, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Atsuko
authors.initials: A
authors.lastname: Kato
authors.affiliation: Division of Cardiovascular Surgery, The Labatt Family Heart Centre, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Mauro
authors.identifier: http://orcid.org/0000-0002-3175-3764
authors.initials: M
authors.lastname: Lo Rito
authors.affiliation: Divisions of Cardiology, The Labatt Family Heart Centre, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Kyong-Jin
authors.initials: KJ
authors.lastname: Lee
authors.affiliation: Division of Cardiovascular Surgery, The Labatt Family Heart Centre, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Christoph
authors.initials: C
authors.lastname: Haller
authors.affiliation: Critical Care Medicine, The Labatt Family Heart Centre, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Guerguerian
authors.affiliation: Critical Care Medicine, The Labatt Family Heart Centre, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Venkatesan Ben
authors.initials: VB
authors.lastname: Sivarajan
authors.affiliation: Division of Cardiovascular Surgery, The Labatt Family Heart Centre, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Osami
authors.initials: O
authors.lastname: Honjo
mesh_terms: D006328:Cardiac Catheterization / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007432:Intraoperative Period; D008297:Male; D009864:Ontario / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
keywords: ECMO complication; mechanical support; pediatric