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Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
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Utility of cardiac catheterization in pediatric cardiac patients on ECMO

S E desJardins1, D C Crowley, R H Beekman

  • 1Division of Pediatric Cardiology, C.S. Mott Children's Hospital, Ann Arbor, Michigan 48104-0204, USA.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|May 29, 1999
PubMed

Insights

Cardiac catheterization is feasible in children on extracorporeal membrane oxygenation (ECMO), offering valuable diagnostic and interventional benefits. However, long-term survival for these critically ill pediatric patients remains poor.

Area of Science:

  • Pediatric Cardiology
  • Cardiovascular Surgery
  • Critical Care Medicine

Background:

  • Extracorporeal membrane oxygenation (ECMO) is a life-support measure for critically ill children with cardiac or respiratory failure.
  • Cardiac catheterization is rarely performed in pediatric patients undergoing ECMO due to perceived risks.
  • Congenital heart disease (CHD) is a common indication for ECMO in children.

Purpose of the Study:

  • To evaluate the safety and efficacy of cardiac catheterization in pediatric patients on ECMO.
  • To assess the diagnostic yield and impact on clinical management of catheterization in this population.
  • To determine the outcomes and survival rates of children undergoing catheterization while on ECMO.

Main Methods:

  • Retrospective review of 15 pediatric patients with CHD who underwent cardiac catheterization on ECMO between December 1990 and December 1995.
  • Analysis of procedural success, diagnostic information obtained, changes in clinical management, complications, and survival rates.
  • Inclusion of both diagnostic and interventional catheterization procedures.

Main Results:

  • Catheterization procedures, including four interventions, were successful in all 15 patients.
  • Unexpected diagnostic information was obtained in 40% of cases, significantly altering clinical management in 73%.
  • All patients tolerated the procedure and transport well, with one instance of retroperitoneal hemorrhage. Survival rates were 50% weaning from ECMO, 29% at discharge, and 14% at follow-up.

Conclusions:

  • Diagnostic and interventional cardiac catheterization can be performed safely in pediatric patients on ECMO, with acceptable morbidity and mortality.
  • While catheterization provides valuable clinical information and management changes, the overall long-term survival for this high-risk pediatric population remains poor.
  • Further research is needed to improve outcomes for children requiring both ECMO and cardiac catheterization.

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