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Cardiac catheterization procedures in pediatric patients undergoing extracorporeal membrane oxygenation cardiac
Alper Güzeltaş1, Taner Kasar, İbrahim Cansaran Tanıdır
1Department of Pediatric Cardiology, İstanbul Sağlık Bilimleri University, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, İstanbul-Turkey. alperguzeltas@hotmail.com.
Insights
Cardiac catheterization is safe and effective for pediatric patients on extracorporeal membrane oxygenation (ECMO). Early angiography can clarify or treat issues if ECMO weaning is unsuccessful.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Extracorporeal membrane oxygenation (ECMO) is a critical intervention for pediatric patients experiencing severe respiratory or cardiovascular failure.
- Cardiac catheterization is a valuable diagnostic and therapeutic tool in pediatric cardiac care.
Purpose of the Study:
- To evaluate the outcomes of cardiac catheterization procedures performed on pediatric patients requiring ECMO support.
- To assess the safety and efficacy of both diagnostic and interventional catheterization in this high-risk population.
Main Methods:
- Retrospective review of clinical data from 16 pediatric patients who underwent cardiac catheterization while on ECMO support between January 2012 and October 2016.
- Analysis included patient demographics, catheterization types (diagnostic vs. interventional), specific procedures performed, complications, and outcomes related to ECMO weaning and discharge.
Main Results:
- Cardiac catheterization was performed on 16 pediatric patients on ECMO, with a median age of 6.5 months.
- Eight diagnostic and eight interventional procedures were completed, including various stenting and angioplasty techniques. One patient experienced transient atrioventricular block, and minor vascular complications occurred in three patients.
- Successful weaning from ECMO was achieved in 75% of patients, and 63% were discharged.
Conclusions:
- Diagnostic and interventional cardiac catheterization can be safely and effectively performed in pediatric patients supported by ECMO.
- Early angiography is recommended for patients unable to be weaned from ECMO to identify and address underlying problems.
Objective:
Extracorporeal membrane oxygenation (ECMO) is a lifesaving intervention for pediatric patients with respiratory and/or cardiovascular failure. In this study, we evaluated the cardiac catheterization results of pediatric patients on ECMO support.
Methods:
Between January 2012 and October 2016, 98 patients (5.2% of all surgery patients) needed ECMO support during perioperative cardiac surgery. We retrospectively reviewed the clinical data of 16 patients who underwent cardiac catheterization under ECMO support.
Results:
The median age at catheterization was 6.5 months (range, 3.3-60 months), and the median weight was 6.0 kg (range, 3.7-16 kg ). Eight of the catheterizations were diagnostic, and the remaining eight were interventional. Five out of these eight patients underwent surgical palliation after diagnostic catheterization. Right pulmonary artery (RPA) stenting, right ventricular outflow tract (RVOT) stenting, combined left pulmonary artery (LPA) and RVOT stenting, combined LPA and modified Blalock-Taussig shunt stenting, bilateral pulmonary artery balloon angioplasty, and bilateral pulmonary artery stenting were each performed once, whereas LPA stenting was performed in two different patients. In one patient undergoing RVOT stenting, a complete atrioventricular block developed, resulting in hypotension; however, this was overcome with an ECMO flow increase. In another patient, the ECMO tubing disconnected from the arterial line. Minor vascular complications were seen in three patients. Twelve patients (75%) were successfully weaned from ECMO after the procedure and ten (63%) were discharged.
Conclusion:
Diagnostic and interventional cardiac catheterization can be safely and effectively performed in patients on ECMO. If the patient cannot be weaned from ECMO support, clinicians should consider performing an early angiogram either to treat or clarify the underlying problem.
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