A Critical Analysis of Extracorporeal Membrane Oxygenation for Congenital Diaphragmatic Hernia

Bailey, Patrick V.; Connors, Robert H.; Tracy, Thomas F.; Stephens, Cindy; Pennington, D. Glenn; Weber, Thomas

doi:10.1097/00132586-199008000-00058

Cited by 12 publications

(7 citation statements)

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“…To this end, allowing a certain level of hypercapnea to persist is becoming a more accepted approach to patients with CDH [7,[16][17][18] and to effect this, lower settings for IMV and HFOV are being used with inhaled NO. ECMO is used at many centers as a salvage treatment if a patient's condition is unstable, but it can cause complications secondary to bleeding, which is costly [8], and appears to have no significant effect on mortality in CDH patients [4].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of protocolized management for congenital diaphragmatic hernia. A review of 100 cases

et al. 2006

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A review of 100 consecutive cases of congenital diaphragmatic hernia (CDH) treated at our institute focusing on the efficacy of protocolized management (PM) was conducted. Of the 100 cases, 14 who became symptomatic more than 24 h after birth, and seven with fatal anomalies (four cardiac and three chromosomal) were excluded, leaving 79 subjects for this study. Of these, 41 were diagnosed prenatally (PD). Subjects were divided into four groups. Group I: No PD, no PM (n = 34), Group II: No PD, PM (n = 4), Group III: PD, no PM (n = 21), and Group IV: PD, PM (n = 20). PM includes criteria for planned delivery, use of high frequency oxygenation, nitric oxide, echocardiography (EC), and a medication schedule. Overall survival rates for Groups I, II, III, and IV were 73.5% (25/34), 75% (3/4), 38.1% (8/21), and 70.0% (14/20), respectively. Survival rates were higher when PM was used: 70.8% (Groups II, IV) versus 60.0% (Groups I, III). Survival rates were significantly lower if diagnosed prenatally (PD+): 53.7% (Groups III, IV) versus 73.7% (Groups I, II) (P < 0.01). However, in PD+ groups, survival was significantly higher if PM was used (P < 0.05). PM significantly reduced length of hospital stay (35.5 vs. 52.0 days: P < 0.05). EC was found to be a predictor for survival while post-ductal AaDO(2) was not. In 17 cases with cardiac anomalies, PM did not affect survival. Our study suggests that use of PM for prenatally diagnosed CDH cases is associated with improved outcome, although the components of PM need to be tested in prospective trials to determine their true value.

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Section: Discussionmentioning

confidence: 99%

Efficacy of protocolized management for congenital diaphragmatic hernia. A review of 100 cases

et al. 2006

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“…The introduction of extracorporeal support (ECMO) in the late 1970s seemed to improve survival, documented in several series. [2][3][4][5][6] The use of ECMO was subsequently extended to include immediate ventilator support with ECMO after birth and later repair of the defect either while receiving ECMO 7,8 or after tapering off ECMO support. 9 We have been reluctant to attempt to taper off ECMO support prior to repair in those infants who receive ECMO immediately after birth, because of the known deterioration in pulmonary function after CDH repair.…”

Section: Commentmentioning

confidence: 99%

Improved Survival in Congenital Diaphragmatic Hernia With Evolving Therapeutic Strategies

et al. 1998

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“…[26][27][28] It is also significant to note that Bohn's criteria were generated in an era before ECMO and that when applied to patients in ECMO centers, it was not predictive as in the present study. 29 Our bedside ventilator flow-loop dynamics approach is pragmatic because other methods of assessing lung volume and pulmonary function are not always readily available. Most pulmonary measurements require separate training and specialized equipment instead of a conventional ventilator.…”

Section: Discussionmentioning

confidence: 99%

Bedside Lung Mechanics Predict Survival in Hypoplastic Lung Disease

et al. 2010

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Newer bedside pulmonary mechanics using conventional ventilators allow for CONTINUOUS serial determinations of tidal volume (V(T)). We sought to determine whether the degree of pulmonary hypoplasia could be measured using bedside pulmonary graphics and whether survival could be predicted in potential extracorporeal membrane oxygenation (ECMO) candidates. Data on all neonates considered for or treated with ECMO at our center between April 2000 and March 2005 were collected. The "maximal bedside V(T)" was measured daily at the peak pressure where "beaking" began with a peak end expiratory pressure of 4 cm H(2)O. Twenty-two patients were reviewed: eight ECMO plus fourteen similar patients in whom the threshold for ECMO intervention was not achieved. Independent of need for ECMO, any patient with V(T) of < 3 mL/kg or < 0.2 mL/cm length died ( N = 4). All other measures of lung capacity or blood gas assessments were less valuable than V(T) in predicting survival. We conclude that bedside V(T) can be easily measured and that values < 3 mL/kg or < 0.2 mL/cm length demarcate severe lung hypoplasia, which in our patient population was incompatible with survival. We speculate that bedside V(T) may assist in evaluating the utility of ECMO.

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A Critical Analysis of Extracorporeal Membrane Oxygenation for Congenital Diaphragmatic Hernia

Cited by 12 publications

References 0 publications

Efficacy of protocolized management for congenital diaphragmatic hernia. A review of 100 cases

Efficacy of protocolized management for congenital diaphragmatic hernia. A review of 100 cases

Improved Survival in Congenital Diaphragmatic Hernia With Evolving Therapeutic Strategies

Bedside Lung Mechanics Predict Survival in Hypoplastic Lung Disease

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