Congenital diaphragmatic hernia with or without extracorporeal membrane oxygenation: are we making progress?
Publication/Presentation Date
7-1-1995
Abstract
BACKGROUND: Congenital diaphragmatic hernia (CDH) continues to have a high mortality rate (24 to 57 percent) despite changing management schemes, which include extracorporeal membrane oxygenation (ECMO) for treatment of associated persistent pulmonary hypertension of the newborn.
STUDY DESIGN: The medical records of 123 acutely symptomatic newborns with CDH treated from 1972 to 1994 were retrospectively reviewed. Patients were divided into three groups to compare historical treatment modalities: group 1, no ECMO available; group 2, postoperative ECMO if necessary; and group 3, delayed repair with preoperative ECMO if necessary. The blood gas values, alveolar-arterial oxygen gradient (A-aDO2), mean airway pressure (MAP), and oxygenation (OI) and ventilation indices (VI) prior to treatment were compared between survivors and nonsurvivors. Chi-square and Student's t tests were used to determine statistical significance.
RESULTS: The overall survival rate was 41 percent: 27 percent in group 1, 45 percent in group 2, and 39 percent in groups 3. If those who were not candidates for ECMO were excluded from analysis, the survival rate improved to 35 percent in group 1, 51 percent in group 2, and 50 percent in group 3. No published prognostic scoring system, such as arterial blood gas values, A-aDO2 gradient, MAP, OI, or VI consistently distinguished survivors from nonsurvivors. Extracorporeal membrane oxygenation decreased the mortality rate of patients having large defects.
CONCLUSIONS: Prognostic scoring systems do not predict which patients with CDH should be treated. Extracorporeal membrane oxygenation has improved survival in newborns with CDH who present in early respiratory distress. There is no advantage or disadvantage to using ECMO prior to repair of CDH.
Volume
181
Issue
1
First Page
65
Last Page
71
ISSN
1072-7515
Published In/Presented At
Lessin, M. S., Thompson, I. M., Deprez, M. F., Cullen, M. L., Whittlesey, G. C., & Klein, M. D. (1995). Congenital diaphragmatic hernia with or without extracorporeal membrane oxygenation: are we making progress?. Journal of the American College of Surgeons, 181(1), 65–71.
Disciplines
Medicine and Health Sciences | Pediatrics
PubMedID
7599774
Department(s)
Department of Pediatrics, Department of Surgery
Document Type
Article