Original article
Factors associated with survival in infants with congenital diaphragmatic hernia requiring extracorporeal membrane oxygenation: a report from the Congenital Diaphragmatic Hernia Study Group

https://doi.org/10.1016/j.jpedsurg.2008.12.021Get rights and content

Abstract

Objective

To identify factors associated with survival in patients with congenital diaphragmatic hernia (CDH) treated with extracorporeal membrane oxygenation (ECMO).

Methods

We retrospectively analyzed the data on 3100 patients with CDH in the Congenital Diaphragmatic Hernia Study Group from 82 participating pediatric surgical centers (1995-2004). Covariates considered included prenatal and perinatal clinical information, specifics of surgical repair, and the duration of extracorporeal support.

Result

Nine hundred seven patients from the registry were identified as having been both managed with ECMO and undergone attempted surgical repair. The survival rate for the entire Congenital Diaphragmatic Hernia Study Group registry was 67% and 61% for those receiving ECMO in whom repair was attempted (P < .001). Among ECMO-treated children, survivors had a greater estimated gestational age (38 ± 2 vs 37 ± 2 weeks; P < .01), greater birth weights (3.2 ± 0.5 vs 2.9 ± 0.5 kg; P < .001), were less often prenatally diagnosed (53% vs 63%; P < .01), and were on ECMO for a shorter period of time (9 ± 5 vs 12 ± 5 days; P < .001). In logistic regression models, therapy-related variables, including the duration of ECMO, the nature of diaphragmatic repair, and the type of abdominal closure and certain comorbidities, particularly the presence of a concomitant severe cardiac abnormality, were independently associated with outcome.

Conclusion

Our model identifies a group of pre-surgical and postsurgical parameters that predict survival rate in patients with CDH on ECMO support. This model was derived from the retrospective data from a large database and will need to be prospectively tested.

Section snippets

Materials and methods

Cases of congenital diaphragmatic hernia submitted to the congenital diaphragmatic hernia study group from January of 1995 through December 2004 were included. The hospitals participating in this program included 82 centers that provided standardized information to the CDHSG database maintained at Hermann Hospital in Houston, Tex. The database includes numerous measurements describing the perinatal period, the surgical repair used, and details of the ECMO clinical course. We considered chiefly

Results

Data on 3100 patients with CDH were submitted to the Congenital Diaphragmatic Hernia Study Group between January 1995 and December 2004. Of these, 1063 patients (34%) were identified as having been managed with ECMO. Of children treated with ECMO, 160 (15%) did not undergo repair, and all died, leaving 903 cases treated with ECMO in whom repair was undertaken. Thus, overall survival for the entire cohort of children with CDH receiving ECMO was 48%; for those in whom surgical repair was

Discussion

Since the advent of ECMO, several studies have been published supporting both survival advantages [4], [16], [17] and lack of benefits [18], [19] of ECMO for patients with CDH. Few studies have attempted to find predictors of outcome in patients with CDH on ECMO [8], [9], [10], [11], [12]. In an attempt to determine which patients have cardiopulmonary disease incompatible with life, the selection criteria including liver position, prenatal magnetic resonance imaging lung volume measurements,

References (32)

  • AdzickN.S. et al.

    Diaphragmatic hernia in the fetus: prenatal diagnosis and outcome in 94 cases

    J Pediatr Surg

    (1985)
  • NakayamaD.K. et al.

    Prenatal diagnosis and natural history of the fetus with congenital diaphragmatic hernia: initial clinical experience

    J Pediatr Surg

    (1985)
  • FauzaD.O. et al.

    Congenital diaphragmatic hernia and associated anomalies: their incidence, identification, and impact on prognosis

    J Pediatr Surg

    (1994)
  • TiruvoipatiR. et al.

    Predictors of outcome in patients with congenital diaphragmatic hernia requiring extracorporeal membrane oxygenation

    J Pediatr Surg

    (2007)
  • GallotD. et al.

    Prenatal detection and outcome of congenital diaphragmatic hernia: a French registry-based study

    Ultrasound Obstet Gynecol

    (2007)
  • HeissK. et al.

    Reversal of mortality for congenital diaphragmatic hernia with ECMO

    Ann Surg

    (1989)
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