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Updated: Mar 23, 2026
Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting
Published on: January 17, 2025
Early catheterization after initiation of extracorporeal membrane oxygenation support in children is associated with
Boban P Abraham1, Erikka Gilliam1, Dennis W Kim1
1Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia.
Insights
Cardiac catheterization during extracorporeal membrane oxygenation (ECMO) is feasible with low complications. Transcatheter interventions improved survival, particularly in congenital heart disease patients.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Extracorporeal Membrane Oxygenation
Background:
- Limited data exists on outcomes of cardiac catheterization performed on extracorporeal membrane oxygenation (ECMO).
- This study addresses the institutional experience with this complex procedure.
Purpose of the Study:
- To evaluate the safety and efficacy of cardiac catheterization in pediatric patients supported by ECMO.
- To compare outcomes between patients with cardiomyopathy (CM) and congenital heart disease (CHD).
Main Methods:
- Retrospective review of pediatric patients undergoing cardiac catheterization on ECMO between 2003 and 2013.
- Patients were stratified into cardiomyopathy (CM) and congenital heart disease (CHD) groups.
- Outcomes analyzed included survival rates, intervention types, and complication rates.
Main Results:
- Of 215 children on ECMO, 75 (29.8%) underwent catheterization. The median age was 1.5 months.
- Survival to discharge was 83% for CM patients (all underwent atrial septoplasty) and 34.6% for CHD patients.
- Transcatheter interventions in CHD patients were associated with better survival (P < 0.001) compared to surgical interventions or no intervention.
- Mean ECMO-to-catheterization time was shorter for survivors (1.6 days) than non-survivors (3.5 days, P = 0.034).
- Major catheterization complication rate was low at 6.7%.
Conclusions:
- Cardiac catheterization and transcatheter interventions on ECMO are feasible with a low complication rate.
- Early catheterization after ECMO initiation and transcatheter interventions are associated with improved survival.
- Cardiomyopathy patients demonstrated better survival outcomes compared to congenital heart disease patients.
Objectives:
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.
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