CLINICAL STUDY: CONGENITAL HEART DISEASE
Cardiac catheterization of patients supported by extracorporeal membrane oxygenation
Karen L. Booth, MD*,*,
Stephen J. Roth, MD, MPH*,
Stanton B. Perry, MD*,
Pedro J. del Nido, MD ,
David L. Wessel, MD* and
Peter C. Laussen, MBBS*
* Department of Cardiology, Children’s Hospital Boston, Boston, Massachusetts, USA
Department of Cardiovascular Surgery, Children’s Hospital Boston, Boston, Massachusetts, USA
Manuscript received January 22, 2002;
revised manuscript received April 7, 2002,
accepted June 26, 2002.
* Reprint requests and correspondence: Dr. Karen L. Booth, Critical Care Medicine Offices, 6th Floor, Children’s Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, Pennsylvania 19104, USA.
karenlbooth{at}msn.com
OBJECTIVES: The goal of this study was to describe the clinical outcomes of patients undergoing cardiac catheterization while supported with extracorporeal membrane oxygenation (ECMO).
BACKGROUND: Extracorporeal membrane oxygenation is an important mechanical support for the failing circulation. There are diagnostic and therapeutic indications for cardiac catheterization in patients on ECMO, but no large series has been reported.
METHODS: We performed a retrospective review of the indications and outcomes of patients catheterized on ECMO from a single, large pediatric tertiary care center.
RESULTS: At our institution, 192 patients with cardiac disease have undergone a total of 216 courses of ECMO; 60 catheterizations were performed on 54 patients (28%). Indications for catheterization included assessment of surgical repair (21 patients), left heart decompression (12 patients), myocarditis/cardiomyopathy assessment (10 patients), non-post-operative hemodynamic assessment (8 patients), planned catheter-based interventions (6 patients), and arrhythmia ablation (3 patients). An intervention was undertaken either during or after 50 of the catheterizations (83%); 29 occurred at catheterization, 17 in the operating room (OR), and 4 both during catheterization and in the OR. Complications during catheterization were two myocardial perforations that were treated with pericardial drains (3%). Overall outcomes included successful decannulation of 39 patients, survival to hospital discharge of 26 (48%) patients, and longer-term survival of 23 (43%) patients (median follow-up, 35 months; range, 1 to 180 months). Fifteen patients were withdrawn from ECMO support due to severe neurologic impairment or lack of myocardial recovery.
CONCLUSIONS: Cardiac catheterization can be performed safely on patients supported with ECMO. Catheterization during ECMO enables the diagnosis of residual lesions and can facilitate important therapeutic interventions.
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Abbreviations and Acronyms
| | CPB | | cardiopulmonary bypass | | ECMO | | extracorporeal membrane oxygenation | | ICU | | intensive care unit | | OR | | operating room | | SVT | | supraventricular tachycardia |
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