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Neonatal congenital diaphragmatic hernia and extracorporeal membrane oxygenation
N N Finer1, A J Tierney, R Hallgren
1Department of Newborn Medicine, Royal Alexandra Hospital, Edmonton, Alta.
Insights
Extracorporeal membrane oxygenation (ECMO) can improve survival for infants with congenital diaphragmatic hernia (CDH) who do not respond to conventional treatments. This study found ECMO beneficial for high-risk CDH neonates, despite complications like bleeding.
Area of Science:
- Neonatal Medicine
- Pediatric Surgery
- Critical Care
Background:
- Congenital diaphragmatic hernia (CDH) is a serious condition requiring advanced respiratory support.
- Early referral for extracorporeal membrane oxygenation (ECMO) is crucial for neonates with severe CDH.
- Predicting outcomes in CDH remains challenging.
Purpose of the Study:
- To evaluate the outcomes of infants with congenital diaphragmatic hernia (CDH) referred for extracorporeal membrane oxygenation (ECMO).
- To assess the effectiveness of ECMO in neonates with severe CDH.
- To identify factors influencing survival in CDH patients undergoing ECMO.
Main Methods:
- Retrospective descriptive study of 15 infants referred for ECMO.
- 13 infants received ECMO, with cannulation of the carotid artery and jugular vein.
- ECMO initiation criteria included an oxygen index > 40 on three occasions within 2 hours.
Main Results:
- Five of 13 infants received ECMO post-surgical repair and survived.
- Four of six infants receiving ECMO during repair survived.
- No established predictors of outcome were useful; bleeding was the most common complication and cause of death.
Conclusions:
- ECMO is associated with improved survival in infants with CDH who have a poor prognosis despite conventional therapy.
- ECMO can be a life-saving intervention for neonates with severe congenital diaphragmatic hernia.
- Further research is needed to optimize ECMO strategies and mitigate complications in CDH management.
Objective:
To describe the outcome of infants with congenital diaphragmatic hernia (CDH) presenting early who were referred for possible extracorporeal membrane oxygenation (ECMO).
Design:
Retrospective descriptive study.
Setting:
Neonatal Intensive Care Unit of the Royal Alexandra Hospital, Edmonton.
Patients:
Fifteen infants referred to our program since its introduction, in February 1989; 13 received ECMO. The criterion for ECMO was the presence of an oxygen index of more than 40 on three occasions within 2 hours.
Intervention:
ECMO was performed by means of cannulation of the right carotid artery and jugular vein for 111.0 hours on average.
Results:
In 5 of the 13 infants who underwent ECMO the procedure was performed after surgical repair; all were successfully weaned off ECMO, and the cannula was removed without incident. In the remaining eight ECMO was started before surgical repair; of the six who received it during repair four ultimately survived. None of the previously described predictors of outcome for CDH, including diagnosis before 25 weeks' gestation (in six cases), were useful in determining the survival of the patients. Bleeding was the most common complication and cause of death.
Conclusion:
ECMO is associated with survival in infants with CDH who fail to respond to conventional therapy and who have a poor prognosis according to previously established criteria.