Accessing extracorporeal membrane oxygenation circuits to perform emergent interventional cardiac catheterisation

Area of Science:

• Cardiology
• Pediatric Cardiology
• Cardiovascular Surgery

Background:

• Cardiac catheterization during extracorporeal membrane oxygenation (ECMO) can provide critical diagnostic information.
• Complications, particularly access site issues, are common during ECMO-supported cardiac catheterization.
• Hypoplastic left heart syndrome (HLHS) patients post-Norwood I are susceptible to decompensation due to shunt obstruction.

Purpose of the Study:

• To describe a straightforward technique for emergent cardiac catheterization in HLHS patients on ECMO.
• To evaluate the utility of ECMO circuit access for cardiac catheterization in complex congenital heart disease.

Main Methods:

• A novel technique for accessing the ECMO circuit was employed.
• Emergent cardiac catheterization was performed in two HLHS patients experiencing decompensation after Norwood I procedure.
• Assessment focused on identifying and addressing systemic-to-pulmonary artery shunt obstruction.

Main Results:

• The described technique allowed for successful emergent cardiac catheterization via the ECMO circuit.
• Therapeutic plans were modified based on findings, addressing newly recognized or residual lesions.
• The procedure facilitated the management of presumed systemic-to-pulmonary artery shunt obstruction.

Conclusions:

• Emergent cardiac catheterization via ECMO circuit access is feasible and can be life-saving.
• This technique offers a valuable option for HLHS patients with suspected shunt-related complications on ECMO.
• Successful intervention can lead to improved therapeutic strategies and patient outcomes.