Cardiac catheterizations and interventions can be performed safely on pediatric patients on extracorporeal membrane oxygenation (ECMO); however, this patient population has an increased risk of adverse events vs. patients not on ECMO, according to a first-of-its-kind multicenter review recently published in the Journal of the Society for Cardiovascular Angiography & Interventions.

Using data from ACC's IMPACT Registry from 2011 to 2022, Kelsey D. McLean, MD, et al., included 3,473 cardiac catheterization procedures conducted on 2,980 pediatric patients on ECMO (mean age 2.71 ± 4.81, 31.6% with single ventricle physiology), seeking insights into the characteristics and outcomes of these patients.

Overall, 53.2% of patients analyzed survived to hospital discharge. Among these patients, 45.2% had single ventricle physiology while 56.8% had biventricular physiology. Additionally, interventional procedures were performed in 52.5% of cases.

Major adverse events were noted in 11.5% of cases. Most common adverse events included arrhythmia (3.3%), bleeding events (2.7%), and unplanned cardiac (1.8%) or other surgeries (1.8%). Of note, patients with single ventricle physiology were more likely to experience major adverse events (odds ratio, 1.31: 95% CI, 1.02-1.69). Other predictors of adverse events were interventional procedures, female sex, non-Hispanic race, diabetes mellitus, a salvage vs. elective procedure status, and systemic heparinization.

The authors note this study "demonstrated a relatively low procedural risk given the clinical acuity of these patients, but about double the risk associated with cardiac catheterization in pediatric patients not on ECMO."

They add that with so few data available on the safety of cardiac catheterization for pediatric patients supported by ECMO, this large-scale multicenter study "provides benchmarking data for quality improvement, as well as for future studies aimed at further improving the performance of said procedures."