Identifying neonates at a very high risk for mortality among children with congenital diaphragmatic hernia managed with extracorporeal membrane oxygenation

Acute kidney injury in congenital diaphragmatic hernia requiring extracorporeal life support: an insidious problem

“…The mortality in patients with severe CDH requiring ECLS is approximately 40% to 50% [10][11][12]. Survival in our patients was 54%, which is consistent with the published survival rates.…”

“…Therapies used to treat severe CDH include inhaled nitric oxide [3], high-frequency oscillatory ventilation [4,5], surfactant [6,7], and extracorporeal life support (ECLS) [8,9]. Despite these interventions, morbidity and mortality of patients with severe CDH remain high, with an overall survival of 69% and 40% to 50% among patients receiving ECLS [10][11][12]. Several studies have sought to identify variables that would stratify the risk of mortality in patients with CDH requiring ECLS [11][12][13][14].…”

“…Despite these interventions, morbidity and mortality of patients with severe CDH remain high, with an overall survival of 69% and 40% to 50% among patients receiving ECLS [10][11][12]. Several studies have sought to identify variables that would stratify the risk of mortality in patients with CDH requiring ECLS [11][12][13][14]. Acute kidney injury (AKI) and the requirement for continuous renal replacement therapy (CRRT) or dialysis have been identified as potentially important risk factors for mortality in patients with CDH requiring ECLS [12][13][14].…”

Congenital diaphragmatic hernia

“…Meta-analysis of three randomised controlled trials (RCTs) (only 39 infants in total) indicated a reduction in early mortality with ECMO, but no long-term benefits [55]. Prediction scores may be useful to identify those at very high risk of mortality amongst infants managed with ECMO [56]. Survival appears higher if surgical repair is after ECMO, rather than when the infant is on ECMO [57].…”

Surgical Conditions of the Diaphragm: Posterior Diaphragmatic Hernias in Infants

“…As pulmonary hypoplasia remains the leading cause of death of CDH patients on ECMO, it is clear that ECMO does not reverse the underlying pulmonary defect in CDH and that its use may be futile in patients with lethal pulmonary hypoplasia (ie, those who have never demonstrated normal PaO 2 levels). 39 In many centers, ventilatory criteria for ECMO cannulation include the inability to maintain preductal oxygen saturations greater than 85%; peak inspiratory pressure greater than 28 cm H 2 O or mean airway pressure greater than 15 cm H 2 O; pressure-resistant hypotension; inadequate oxygen delivery based on persistent metabolic acidosis or rising serum lactate level; and inability to wean from fraction of inspired oxygen (FiO 2 ) 100% in the first 48 hours of life. When the patient requires more than the set level of ventilatory support, clinicians use ECMO rather than escalate the settings on positive-pressure ventilation.…”