Booth Karen L, Roth Stephen J, Perry Stanton B, del Nido Pedro J, Wessel David L, Laussen Peter C
Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts, USA.
J Am Coll Cardiol. 2002 Nov 6;40(9):1681-6. doi: 10.1016/s0735-1097(02)02343-4.
The goal of this study was to describe the clinical outcomes of patients undergoing cardiac catheterization while supported with extracorporeal membrane oxygenation (ECMO).
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.
We performed a retrospective review of the indications and outcomes of patients catheterized on ECMO from a single, large pediatric tertiary care center.
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 Fifteen patients were withdrawn from ECMO support due to severe neurologic impairment or lack of myocardial recovery.
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.
本研究的目的是描述在体外膜肺氧合（ECMO）支持下接受心导管检查的患者的临床结局。
体外膜肺氧合是对衰竭循环的重要机械支持。对于接受ECMO治疗的患者，存在心导管检查的诊断和治疗指征，但尚无大型系列报道。
我们对一家大型儿科三级护理中心接受ECMO导管插入术的患者的指征和结局进行了回顾性研究。
在我们机构，192例心脏病患者共接受了216个疗程的ECMO治疗；54例患者（28%）进行了60次心导管检查。导管插入术的指征包括评估手术修复情况（21例患者）、左心减压（12例患者）、心肌炎/心肌病评估（10例患者）、非术后血流动力学评估（8例患者）、计划性基于导管的干预措施（6例患者）和心律失常消融（3例患者）。50次导管插入术（83%）期间或之后进行了干预；29次在导管插入术时进行，17次在手术室（OR）进行，4次在导管插入术期间和手术室均进行。导管插入术期间的并发症为2例心肌穿孔，经心包引流治疗（3%）。总体结局包括39例患者成功拔管，26例（48%）患者存活至出院，23例（43%）患者长期存活（中位随访时间35个月；范围1至180个月）。15例患者因严重神经功能障碍或心肌未恢复而停止ECMO支持。
在接受ECMO支持的患者中可以安全地进行心导管检查。ECMO期间的导管插入术能够诊断残余病变，并有助于进行重要的治疗干预。
