title: Early Cardiac Catheterization Leads to Shortened Pediatric Extracorporeal Membrane Oxygenation Run Duration.
abstract: OBJECTIVE
  Cardiac catheterization in patients receiving extracorporeal life support (ECLS) has previously been shown to be safe and, in many cases, therapeutic. However, the influence of cardiac catheterization on clinical outcomes in this patient population has not been clearly defined.
  
  
  METHODS
  A single institution, retrospective review of all pediatric cardiac ECLS patients who underwent cardiac catheterization between January 2006 and September 2015 was performed.
  
  
  RESULTS
  Eighty-two interventional cardiac catheterization procedures were performed on 74 patients. Catheterization findings directly led to catheterization-based or surgical intervention in 54 (73%) patients. One (1.2%) catheterization-related complication occurred (pulmonary artery rupture), which ultimately resulted in death. Patients who underwent early catheterization (≤72 hours of ECLS initiation) required shorter total duration of ECLS than patients who underwent catheterization >72 hours after ECLS initiation (136 hours vs. 227 hours, P < 0.01). The groups experienced similar rates of interventions based on catheterization findings (72% early cath vs. 74% late cath, P = 0.81). Survival to hospital discharge was higher in the early catheterization group (74% vs. 51%, P = 0.04). In multivariate models adjusting for covariates, early catheterization was associated with a reduction in ECLS duration by approximately 150 hours (P < 0.01).
  
  
  CONCLUSIONS
  Cardiac catheterization is safe in pediatric ECLS patients and an earlier catheterization is associated with shorter duration of ECLS and improved hospital survival. Diagnostic cardiac catheterization should be considered in patients who remain dependent on ECLS after several days of support.
authors.affiliation: Division of Cardiac Surgery, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Burke
authors.affiliation: Division of Critical Care Medicine, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Titus
authors.initials: T
authors.lastname: Chan
authors.affiliation: Division of Cardiology, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Agustin E
authors.initials: AE
authors.lastname: Rubio
authors.affiliation: Division of Cardiac Surgery, Seattle Children's Hospital, Seattle, Washington.
authors.forename: David M
authors.initials: DM
authors.lastname: McMullan
mesh_terms: D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D010351:Patient Discharge; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome