title: Cardiac Catheterization in Pediatric Patients Supported by Extracorporeal Membrane Oxygenation: A 15-Year Experience.
abstract: Cardiac catheterization is commonly performed in patients being supported by extracorporeal membrane oxygenation (ECMO). We aimed to evaluate the safety, benefit, and outcomes of catheterization in pediatric patients supported by ECMO. Retrospective review of cardiac catheterizations performed in patients ≤18 years of age while on ECMO at a large tertiary care center between January 2000 and May 2015. A total of 55 catheterizations were performed on 51 patients during 53 unique ECMO courses. Indications for ECMO include ventricular dysfunction (22), cardiac arrest (20), inability to wean from cardiopulmonary bypass (7), and persistent cyanosis (4). Catheterizations included purely diagnostic studies (11), atrial septostomies (34), stenting of vessels or surgical shunts (6), adjustment of a stent (1), coil embolization (1), and endomyocardial biopsy (1). Septostomy was elective in 58.8% of cases (20) and emergent in 41.2% (14). Forty-six catheterizations had either surgical or catheter intervention during the same or subsequent study (83.6%). High severity complications occurred in three patients (5.6%), including one death due to hemothorax after pulmonary artery stent placement. There were no complications during patient transport. In total, 38 out of 53 (71.7%) ECMO courses resulted in decannulation, 29 (54.7%) patients survived to discharge from the hospital, and 25 (47.2%) were alive at follow-up. Cardiac catheterization can be safely performed on patients supported by ECMO. Cardiac catheterization is a critical tool in the early recognition, diagnosis, and direct treatment of hemodynamic/anatomic abnormalities in patients supported by ECMO.
authors.affiliation: Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of New York, Columbia University Medical Center, 3959 Broadway, BH2N, New York, NY, 10032, USA. nsb7001@nyp.org.
authors.forename: Nicholas S
authors.identifier: http://orcid.org/0000-0003-2692-5725
authors.initials: NS
authors.lastname: Boscamp
authors.affiliation: Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of New York, Columbia University Medical Center, 3959 Broadway, BH2N, New York, NY, 10032, USA.
authors.forename: Mariel E
authors.initials: ME
authors.lastname: Turner
authors.affiliation: Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of New York, Columbia University Medical Center, 3959 Broadway, BH2N, New York, NY, 10032, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Crystal
authors.affiliation: Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of New York, Columbia University Medical Center, 3959 Broadway, BH2N, New York, NY, 10032, USA.
authors.forename: Brett
authors.initials: B
authors.lastname: Anderson
authors.affiliation: Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of New York, Columbia University Medical Center, 3959 Broadway, BH2N, New York, NY, 10032, USA.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Vincent
authors.affiliation: Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of New York, Columbia University Medical Center, 3959 Broadway, BH2N, New York, NY, 10032, USA.
authors.forename: Alejandro J
authors.initials: AJ
authors.lastname: Torres
mesh_terms: D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D009518:New York; D010351:Patient Discharge; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate; D062606:Tertiary Care Centers; D016896:Treatment Outcome
keywords: Cardiac catheterization; Congenital heart disease; Extracorporeal life support; Extracorporeal membrane oxygenation; Interventional; Pediatrics