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. 1989 Feb;209(2):225–230. doi: 10.1097/00000658-198902000-00014

Reversal of mortality for congenital diaphragmatic hernia with ECMO.

K Heiss 1, P Manning 1, K T Oldham 1, A G Coran 1, T Z Polley Jr 1, J R Wesley 1, R H Bartlett 1
PMCID: PMC1493900  PMID: 2644900

Abstract

Extracorporeal Membrane Oxygenation (ECMO) has been available to neonates with respiratory failure at the University of Michigan School of Medicine since June 1981. In order to evaluate the impact of this type of pulmonary support, a retrospective analysis of 50 neonates with posterolateral congenital diaphragmatic hernia (CDH) who were symptomatic during the first hour of life and were treated between June 1974 and December 1987 was carried out. The patients were divided into two groups, those treated before June 1981 (16 patients) and those treated after June 1981 (34 patients). Overall survival improved from 50% (eight of 16 patients) during the pre-ECMO era to 76% (26 of 34 patients) during the post-ECMO period (p = 0.06). During the period after June 1981, 21 neonates were unresponsive to conventional therapy and were therefore considered for ECMO. Failure of conventional therapy was defined as acute clinical deterioration with an expected mortality of greater than 80% based on an objective formula previously reported. Six patients were excluded on the basis of specific contraindications to ECMO. Thirteen of 15 infants (87%) supported with ECMO survived. Three patients treated before 1981 met criteria for ECMO; all three died while receiving treatment using conventional therapy. These survival differences are significant (p less than 0.01). In addition, the survival of 87% for the infants treated with ECMO versus the expected mortality of greater than 80% for these same patients when treated with conventional therapy is highly significant (p less than 0.005). Based on this data, ECMO appears to be a successful, reliable, and safe method of respiratory support for selected, critically ill infants with CDH.

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Selected References

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  1. Adzick N. S., Harrison M. R., Glick P. L., Nakayama D. K., Manning F. A., deLorimier A. A. Diaphragmatic hernia in the fetus: prenatal diagnosis and outcome in 94 cases. J Pediatr Surg. 1985 Aug;20(4):357–361. doi: 10.1016/s0022-3468(85)80219-0. [DOI] [PubMed] [Google Scholar]
  2. Bartlett R. H., Andrews A. F., Toomasian J. M., Haiduc N. J., Gazzaniga A. B. Extracorporeal membrane oxygenation for newborn respiratory failure: forty-five cases. Surgery. 1982 Aug;92(2):425–433. [PubMed] [Google Scholar]
  3. Bartlett R. H., Gazzaniga A. B., Toomasian J., Coran A. G., Roloff D., Rucker R., Corwin A. G. Extracorporeal membrane oxygenation (ECMO) in neonatal respiratory failure. 100 cases. Ann Surg. 1986 Sep;204(3):236–245. doi: 10.1097/00000658-198609000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Benacerraf B. R., Adzick N. S. Fetal diaphragmatic hernia: ultrasound diagnosis and clinical outcome in 19 cases. Am J Obstet Gynecol. 1987 Mar;156(3):573–576. doi: 10.1016/0002-9378(87)90053-6. [DOI] [PubMed] [Google Scholar]
  5. Bohn D. J., James I., Filler R. M., Ein S. H., Wesson D. E., Shandling B., Stephens C., Barker G. A. The relationship between PaCO2 and ventilation parameters in predicting survival in congenital diaphragmatic hernia. J Pediatr Surg. 1984 Dec;19(6):666–671. doi: 10.1016/s0022-3468(84)80350-4. [DOI] [PubMed] [Google Scholar]
  6. Bohn D., Tamura M., Perrin D., Barker G., Rabinovitch M. Ventilatory predictors of pulmonary hypoplasia in congenital diaphragmatic hernia, confirmed by morphologic assessment. J Pediatr. 1987 Sep;111(3):423–431. doi: 10.1016/s0022-3476(87)80474-2. [DOI] [PubMed] [Google Scholar]
  7. Ein S. H., Barker G., Olley P., Shandling B., Simpson J. S., Stephens C. A., Filler R. M. The pharmacologic treatment of newborn diaphragmatic hernia--a 2-year evaluation. J Pediatr Surg. 1980 Aug;15(4):384–394. doi: 10.1016/s0022-3468(80)80741-x. [DOI] [PubMed] [Google Scholar]
  8. Hansen J., James S., Burrington J., Whitfield J. The decreasing incidence of pneumothorax and improving survival of infants with congenital diaphragmatic hernia. J Pediatr Surg. 1984 Aug;19(4):385–388. doi: 10.1016/s0022-3468(84)80258-4. [DOI] [PubMed] [Google Scholar]
  9. Harrison M. R., Bjordal R. I., Langmark F., Knutrud O. Congenital diaphragmatic hernia: the hidden mortality. J Pediatr Surg. 1978 Jun;13(3):227–230. doi: 10.1016/s0022-3468(78)80391-1. [DOI] [PubMed] [Google Scholar]
  10. Johnson D. G., Deaner R. M., Koop C. E. Diaphragmatic hernia in infancy: factors affecting the mortality rate. Surgery. 1967 Dec;62(6):1082–1091. [PubMed] [Google Scholar]
  11. Puri P., Gorman F. Lethal nonpulmonary anomalies associated with congenital diaphragmatic hernia: implications for early intrauterine surgery. J Pediatr Surg. 1984 Feb;19(1):29–32. doi: 10.1016/s0022-3468(84)80010-x. [DOI] [PubMed] [Google Scholar]
  12. Raphaely R. C., Downes J. J., Jr Congenital diaphragmatic hernia: prediction of survival. J Pediatr Surg. 1973 Oct;8(5):815–823. doi: 10.1016/0022-3468(73)90426-0. [DOI] [PubMed] [Google Scholar]
  13. Reynolds M., Luck S. R., Lappen R. The "critical" neonate with diaphragmatic hernia: a 21-year perspective. J Pediatr Surg. 1984 Aug;19(4):364–369. doi: 10.1016/s0022-3468(84)80254-7. [DOI] [PubMed] [Google Scholar]
  14. SNYDER W. H., Jr, GREANEY E. M., Jr CONGENITAL DIAPHRAGMATIC HERNIA; 77 CONSECUTIVE CASES. Surgery. 1965 Apr;57:576–588. [PubMed] [Google Scholar]
  15. Toomasian J. M., Snedecor S. M., Cornell R. G., Cilley R. E., Bartlett R. H. National experience with extracorporeal membrane oxygenation for newborn respiratory failure. Data from 715 cases. ASAIO Trans. 1988 Apr-Jun;34(2):140–147. doi: 10.1097/00002480-198804000-00011. [DOI] [PubMed] [Google Scholar]
  16. Wiener E. S. Congenital posterolateral diaphragmatic hernia: new dimensions in management. Surgery. 1982 Oct;92(4):670–681. [PubMed] [Google Scholar]

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