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Extracorporeal membrane oxygenation in infants with congenital diaphragmatic hernia and cardiac malformations
C A Ryan1, T Perreault, A Johnston-Hodgson
1Department of Pediatrics, Royal Alexandra Hospitals, University of Alberta, Edmonton, Canada.
Insights
Congenital diaphragmatic hernia (CDH) with cardiac anomalies is rare in neonates receiving extracorporeal membrane oxygenation (ECMO). Survival rates suggest ECMO may be viable for select CDH patients with cardiac defects.
Area of Science:
- Neonatal surgery
- Pediatric cardiology
- Extracorporeal life support
Background:
- Congenital diaphragmatic hernia (CDH) is a severe condition requiring advanced respiratory support.
- Neonatal extracorporeal membrane oxygenation (ECMO) is a critical intervention for neonates with respiratory failure.
- The presence of congenital cardiac anomalies in CDH patients complicates ECMO candidacy.
Observation:
- A review of the Extracorporeal Life Support Organization (ELSO) registry from 1973-1992 identified 17 infants with combined CDH and cardiac lesions treated with ECMO.
- The incidence of combined CDH and cardiac lesions among neonates receiving ECMO was 2.5 per 1,000, and 13 per 1,000 for CDH patients on ECMO.
- Five of the 17 infants (29.4%) with combined lesions survived.
Findings:
- Congenital cardiac lesions do not appear to be an absolute contraindication for ECMO in neonates with CDH.
- Survival is possible for neonates with both CDH and significant cardiac anomalies when treated with ECMO.
- The study highlights the importance of individualized assessment for ECMO in complex neonatal cases.
Implications:
- ECMO decisions for CDH infants with cardiac defects should consider the potential outcome of the cardiac anomaly.
- This finding may broaden the eligibility criteria for ECMO in neonates with complex congenital conditions.
- Further research is warranted to refine selection criteria and optimize outcomes for this high-risk population.
Abstract:
Since the introduction of neonatal extracorporeal membrane oxygenation (ECMO) in Canada, the authors have treated three infants with congenital diaphragmatic hernia (CDH) who had serious congenital cardiac anomalies (among 26 infants with CDH treated with ECMO). To determine the incidence of and outcome for infants with combined lesions who received ECMO, 19 years' data (April 1973 to October 1992) from the Extracorporeal Life Support Organization (ELSO) registry were reviewed. Seventeen infants with combined cardiac and diaphragmatic lesions were registered as receiving ECMO in the United States or Canada. Thus, the incidence of combined cardiac and diaphragmatic lesions was 2.5 per thousand neonates (17 of 6,295) receiving ECMO and 13 per thousand neonates (17 of 1,318) receiving ECMO for CDH. Five (29.4%) of the 17 infants survived. A congenital cardiac lesion may not be an absolute contraindication to ECMO in infants with CDH. Decisions to cannulate for ECMO should be based on the potential outcome of the underlying cardiac defect.