Cardiac catheterisation in infants and children on Extra Corporeal Membrane Oxygenation (ECMO) support
Cardiac catheterisation on a patient on ECMO support is a challenging procedure. However timely catheterisation is important for interventional procedures such as decompressing the left atrium or for critical anatomic / physiological information, especially when ECMO weaning is difficult. We reviewed our experience of catheterising infants and children receiving ECMO support.
Patient and Methods: Retrospective case note review of all paediatric patients undergoing cardiac catheterisation while on ECMO support, between August 2004 and May 2008.
Results: please see the attached table
Outcome: Significant abnormality was identified in 6 patients who underwent diagnostic cardiac catheterisation and all of them had subsequent cardiac surgery and came off ECMO. However two patients died subsequently. All patients who underwent radiofrequency ablation made full recovery of their ventricular function. Among the patients with cardiomyopathy who required creating or enlarging inter-atrial communication, one patient required cardiac transplant, the second patient required Berlin heart support for a month and was successfully weaned off and the third had successful surgical repair of abnormal coronary artery anatomy.
Complications from cardiac catheterisation were rare. One patient had excessive bleeding from the vascular access site and another patient had transient desaturation
Conclusion: Both diagnostic and interventional cardiac catheterisation of patients during ECMO support is possible and safe. It is mandatory and should be considered early in patients who fail to wean from ECMO for cardiac support particularly following surgery. Early atrial septostomy for left heart venting is essential to prevent lung consolidation and facilitate recovery of the poorly functioning left ventricle.
|Total number of patients- 13||Life threatening arrhythmia-3||1- 4 years-4||Radiofrequency ablation for arrhythmia-3|
|Total number of procedures-14||Respiratory distress / Sepsis||Diagnostic catheterisation-7||Stenting of branch pulmonary arteries-1|
|Congenital heart disease-7||Newborn - 4||Interventional procedures -7|
|Dilated Cardiomyopathy-2||Infant (1-12 months) - 5||Creating/ enlarging inter atrial communication-3|