Key result
Single ventricle physiology is linked to ~31% higher odds of major events during pediatric ECMO catheterization.
Why the study?
Published studies on the performance and safety of cardiac catheterization in pediatric patients on ECMO were limited, and differences in interventions and outcomes between single ventricle and biventricular physiology were incompletely understood.
What are the safety outcomes and predictors of major adverse events for pediatric patients undergoing cardiac catheterization while supported by ECMO?
Cohort (n=2,980)
Yes
What are the safety outcomes and predictors of major adverse events for pediatric patients undergoing cardiac catheterization while supported by ECMO?
In pediatric patients supported on ECMO, cardiac catheterization is associated with an 11.5% major adverse event rate and 53.2% hospital survival, with single-ventricle physiology and interventional procedures identified as key risk factors.
Single-ventricle physiology was associated with higher catheterization adverse events on ECMO; leaves open whether physiology-specific protocols reduce risk.
Background: There are limited published studies on the performance and safety of cardiac catheterization in pediatric patients on extracorporeal membrane oxygenation (ECMO). We sought to understand the utilization and procedural safety of cardiac catheterization in pediatric patients on ECMO. We also aimed to understand differences in the types of interventions and outcomes in patients with single ventricle (SV) physiology compared to those with biventricular physiology. Methods: Characteristics and outcomes for patients undergoing cardiac catheterization while on ECMO were collected from the American College of Cardiology National Cardiovascular Data Registry: IMPACT (Improving Pediatric and Adult Congenital Treatment) Registry from 2011-2022. Results: There were 3473 cardiac catheterizations performed on 2980 pediatric patients during the study period. Patients with SV comprised 31.6% of the population. Survival to hospital discharge was 53.2% overall, 45.2% in patients with SV, and 56.8% in patients with 2 ventricles. Interventional procedures occurred in 52.5% of cases. Major adverse events occurred in 11.5%, with arrhythmia, bleeding events, and unplanned cardiac/other surgeries being the commonest. Regression analysis found SV was significantly associated with major adverse events, as were interventional procedures, female sex, non-Hispanic race, diabetes mellitus, procedure status classified as salvage vs elective, and systemic heparinization. Conclusions: This is the first large, multicenter review of safety and outcomes in pediatric patients undergoing cardiac catheterization while on ECMO. The study identifies common adverse events during the procedure as well as risk factors associated with the same. The presented data can serve for benchmarking, quality assessment as well as potential future research.
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McLean et al. (2025) conducted a cohort in Pediatric patients on ECMO undergoing cardiac catheterization (n=2,980). Single ventricle physiology vs. Biventricular physiology was evaluated on Major adverse events (MAE) (OR 1.31, 95% CI 1.01-1.69, p=0.04). In pediatric patients on ECMO undergoing cardiac catheterization, single ventricle physiology was significantly associated with an increased risk of major adverse events (OR 1.31) compared to biventricular physiology.
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