Pulse pressure as an early mortality predictor in neonates with congenital diaphragmatic hernia on veno-arterial ECMO

Early prognostic markers for pediatric patients receiving extracorporeal membrane oxygenation (ECMO), particularly those with congenital diaphragmatic hernia (CDH), remain poorly defined. This study aimed to evaluate pulse pressure (PP) as an early hemodynamic indicator of mortality in neonates with CDH undergoing veno-arterial (VA) ECMO.

We retrospectively analyzed newborns who underwent VA ECMO as primary rescue therapy for isolated CDH. Perinatal characteristics, arterial blood gas parameters, and blood pressure (BP) during the first 48 h post-ECMO were evaluated and compared between survivors and non-survivors.

Among 33 neonates, 20 (60.6%) survived. ECMO flow rates or systolic, diastolic, and mean BP did not differ between the group. However, PP at 24 h (20.0 mmHg [17.8-26.3] vs. 12.0 mmHg [10.0-13.0], p < 0.001) and 48 h (24.0 mmHg [20.0-28.8] vs. 12.0 mmHg [10.0-14.0], p < 0.001) post-ECMO was significantly higher in survivors. Receiver operating characteristic analysis demonstrated that PP was am early predictor of survival, with optimal cutoff values of 20 mmHg at 24 h and 17 mmHg at 48 h.

Early recovery of PP was a strong predictor of survival in neonates with CDH requiring VA-ECMO. Further research is required to determine whether interventions to enhance pulsatility can improve clinical outcomes in this high-risk population.