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Recent experience with diaphragmatic hernia and ECMO
C G Howell1, R M Hatley, R F Boedy
1Department of Surgery, Medical College of Georgia Children's Medical Center, Augusta 30912-4070.
Insights
Extracorporeal membrane oxygenation (ECMO) significantly improves survival rates for infants with diaphragmatic hernia. Early referral to ECMO centers is crucial for infants undergoing surgical repair, especially when ECMO is not readily available.
Area of Science:
- Neonatalogy
- Pediatric Surgery
- Cardiopulmonary Support
Background:
- Diaphragmatic hernia is a critical congenital condition requiring complex management.
- Extracorporeal membrane oxygenation (ECMO) offers life support for neonates with severe respiratory failure.
Purpose of the Study:
- To evaluate the impact of ECMO on survival rates in infants with diaphragmatic hernia.
- To assess the outcomes of infants with diaphragmatic hernia managed with and without ECMO.
Main Methods:
- Retrospective analysis of 74 infants treated with ECMO over 4 years.
- Specific focus on 27 infants with diaphragmatic hernia, comparing those who received ECMO post-surgery with those who did not.
Main Results:
- Overall ECMO survival was 84% (62/74).
- For diaphragmatic hernia, 7 of 11 infants (64%) survived with ECMO post-surgery.
- Eight infants died before ECMO initiation, representing potential candidates who might have survived.
Conclusions:
- ECMO, when indicated after diaphragmatic hernia repair, improves oxygen delivery and survival.
- Early referral to ECMO centers is recommended for infants with diaphragmatic hernia awaiting or recovering from surgery.
- Delivery at centers with integrated surgical and ECMO expertise is advised for prenatal diagnoses.
Abstract:
In the past 4 years at the Medical College of Georgia, a total of 74 patients underwent extracorporeal membrane oxygenation (ECMO) with 62 (84%) survivors. Forty-seven of these infants had meconium aspiration syndrome and 11 had diaphragmatic hernia. The use of ECMO, when indicated, after reduction and repair of the diaphragmatic hernia, results in normal oxygen delivery, allows time for pulmonary maturation, and increases survival. A total of 27 referrals for diaphragmatic hernia were studied. Six infants had surgical repair and did not require ECMO. Eleven patients, after surgical repair, were treated with ECMO and seven survived. More importantly 10 patients died before the use of ECMO. Six infants died either before or during transport from referring hospitals and four died while in the delivery room or neonatal unit before ECMO. Of these 10 infants, eight were potential candidates for ECMO. Thirteen of the twenty-seven (48%) infants survived. Seven of eleven (64%) infants who received the benefit of ECMO survived. Eight infants who met the criteria for ECMO died before its use. Had ECMO been used in those eight infants, our data suggests that at least four may have survived. The data from this report support the concept that infants undergoing surgical repair of diaphragmatic hernia, when ECMO is not available, should be referred to an ECMO center in the early postoperative period. Furthermore infants with prenatal diagnosis of diaphragmatic hernia should be delivered at a center where surgical as well as ECMO expertise are available.