Elective Extracorporeal Membrane Oxygenation Support for High-Risk Pediatric Cardiac Catheterization

Abstract

Objective: The utility of extracorporeal membrane oxygenation (ECMO) as an elective support modality for high-risk cardiac procedures is extensively described in adults, but its use in children is limited to isolated reports. The objective of this study was to analyze the outcomes of patients who underwent elective cannulation to ECMO for this purpose.

Design: Single-center, retrospective chart review.

Setting: Free-standing pediatric tertiary care center.

Participants: Patients who underwent elective cannulation to ECMO for cardiorespiratory support during a high-risk cardiac catheterization procedure.

Interventions: Elective ECMO cannulation for high-risk percutaneous cardiac interventions or electrophysiology procedures.

Measurements and main results: Survival to discharge was 71.4% compared with 30% for patients who required extracorporeal cardiopulmonary resuscitation in the cardiac catheterization laboratory. The mean duration of cannulation was 137.43 hours (range 27-615 h, median 55 h). There were no major neurologic sequelae, but ECMO circuit thrombosis (57%) was relatively common.

Conclusion: The use of elective ECMO support for high-risk pediatric cardiac catheterizations can be accomplished safely and may allow for an improved rate of survival with lower rates of severe adverse events compared with extracorporeal cardiopulmonary resuscitation as rescue therapy.

Keywords: cardiac catheterization; cardiopulmonary resuscitation; extracorporeal membrane oxygenation; pediatric; retrospective study; treatment outcome.