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Extracorporeal membrane oxygenation in patients with congenital diaphragmatic hernia
1Department of Surgery, University of Texas-Houston Medical School, USA.
Insights
Extracorporeal membrane oxygenation (ECMO) offers a lifeline for neonates with congenital diaphragmatic hernia (CDH), improving survival rates in high-risk infants. Further research is needed to precisely quantify ECMO
Area of Science:
- Neonatal Medicine
- Pediatric Surgery
- Cardiopulmonary Support
Background:
- Congenital diaphragmatic hernia (CDH) poses a significant risk of mortality in neonates.
- Extracorporeal membrane oxygenation (ECMO) has become a crucial support system for neonatal respiratory failure.
- The application of ECMO for infants with CDH has seen a notable increase.
Purpose of the Study:
- To review the utilization and outcomes of ECMO in infants diagnosed with congenital diaphragmatic hernia.
- To assess the impact of ECMO on survival rates for high-risk CDH patients.
- To evaluate different ECMO configurations (venoarterial vs. venovenous) and surgical repair strategies.
Main Methods:
- Retrospective analysis of single-institution data.
- Inclusion of infants with CDH requiring ECMO support.
- Review of operative techniques and complication rates associated with ECMO and surgical repair.
Main Results:
- ECMO is utilized for high-risk CDH infants with reported survival rates ranging from 38% to 65%.
- Both venoarterial and venovenous ECMO appear effective, with potential for repair on or after ECMO support.
- Improvements in surgical techniques have reduced the complication rate during ECMO-assisted repairs.
Conclusions:
- ECMO support appears to enhance survival for high-risk neonates with CDH.
- The retrospective nature and small sample sizes of existing studies limit precise quantification of ECMO's survival benefit.
- Further comprehensive studies are warranted to definitively establish the value of ECMO in managing CDH.
Abstract:
Since the introduction of extracorporeal membrane oxygenation (ECMO) support for neonatal respiratory failure, the use of ECMO for infants with congenital diaphragmatic hernia has increased significantly. ECMO is offered to infants with a high risk of dying (with reported survival rates of 38% to 65%). Unstable infants can be placed on ECMO with subsequent repair on ECMO or after weaning from support. The complication rate can be high with repair on ECMO, but changes in operative techniques have decreased the risk. Most centers use venoarterial ECMO in patients with congenital diaphragmatic hernia (CDH), but venovenous ECMO appears as effective. ECMO support appears to have improved the survival rate in high-risk infants with CDH, but because almost all studies are retrospective single institutional and have small numbers of patients, the true improvement in survival rate is difficult to quantitate. Further studies of the value of ECMO in patients with CDH are warranted.