Improvement in survival of patients with congenital diaphragmatic hernia utilizing a strategy of delayed repair after medical and/or extracorporeal membrane oxygenation stabilization

Breaux, Charles W.; Rouse, Thomas M.; Cain, Walter S.; Georgeson, Keith E.

doi:10.1016/0022-3468(91)90512-r

Cited by 79 publications

(28 citation statements)

References 13 publications

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“…Roughly 50% of infants with highrisk CDH are treated with ECMO [25,26], the results, however, remain disappointing [2,21,27]. Some authors reported an improved survival rate when incorporating ECMO as a preoperative stabilization or postoperative rescue therapy [26,28,29], while others found a relatively unchanged mortality rate [2,21,22,27,30].…”

Section: Introductionmentioning

confidence: 99%

“…It is difficult to accurately compare results of those studies because each center varies in degree of illness, ventilatory management, timing of surgery, ECMO and selection criteria for ECMO. Another confounding feature of reports of survival in CDH patients treated with ECMO is the unreliability of historic controls [2,26,27]. Furthermore, most studies have a relatively short follow-up period, while significant late mortality has been found in CDH patients treated with ECMO [31].…”

Section: Introductionmentioning

confidence: 99%

“…If the use of ECMO has indeed a beneficial effect on survival, than it might be possible that a larger number of severely affected infants would nowadays survive [32]. It is likely that these infants will have more severe pulmonary hypoplasia and pulmonary hypertension [26,31,33] implying more serious long-term morbidity [31].…”

Section: Introductionmentioning

confidence: 99%

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The long-term follow-up of patients with a congenital diaphragmatic hernia: a broad spectrum of morbidity

et al. 2008

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Congenital diaphragmatic hernia (CDH) is a life-threatening anomaly with a mortality rate of approximately 40-50%, depending on case selection. It has been suggested that new therapeutic modalities such as nitric oxide (NO), high frequency oxygenation (HFO) and extracorporal membrane oxygenation (ECMO) might decrease mortality associated with pulmonary hypertension and the sequelae of artificial ventilation. When these new therapies indeed prove to be beneficial, a larger number of children with severe forms of CDH might survive, resulting in an increase of CDH-associated complications and/or consequences. In follow-up studies of infants born with CDH, many complications including pulmonary damage, cardiovascular disease, gastro-intestinal disease, failure to thrive, neurocognitive defects and musculoskeletal abnormalities have been described. Long-term pulmonary morbidity in CDH consists of obstructive and restrictive lung function impairments due to altered lung structure and prolonged ventilatory support. CDH has also been associated with persistent pulmonary vascular abnormalities, resulting in pulmonary hypertension in the neonatal period.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The long-term follow-up of patients with a congenital diaphragmatic hernia: a broad spectrum of morbidity

et al. 2008

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“…Roughly 50% of infants with high risk CDH are treated with ECMO (Breaux et al, 1991). Survival of CDH infants treated with ECMO is 40% (Aly et al, 2010).…”

Section: The Use Of Extracorporeal Membrane Oxygenation (Ecmo)mentioning

confidence: 99%

Predictors of Mortality and Morbidity in Infants with CDH

Aly¹,

Abdel‐Hady²

2012

Congenital Diaphragmatic Hernia - Prenatal to Childhood Management and Outcomes

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“…These include in utero surgical repair, 4 introduction of extracorporeal membrane oxygenation, 5,6 and an extended period of preoperative stabilization. [7][8][9][10][11][12] Several investigators have proposed extended preoperative medical stabilization followed by delayed repair, but the results of such an approach in terms of overall outcome are controversial. [10][11][12] This report represents our experience with the management of 47 patients with congenital diaphragmatic hernia and analyzes the effect of preoperative stabilization on outcome.…”

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confidence: 99%

Congenital Diaphragmatic Hernia: The Impact of Preoperative Stabilization on Outcome

et al. 1999

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Despite the fact that it is diagnosed antenatally, and despite the availability of improved intensive care, congenital diaphragmatic hernia (CDH) is still associated with high mortality. [1][2][3] To overcome this problem, a variety of techniques have been proposed to decrease the pulmonary vascular resistance, and correct the hypoxia, acidosis and hypotension. These include in utero surgical repair, 4 introduction of extracorporeal membrane oxygenation, 5,6 and an extended period of preoperative stabilization. [7][8][9][10][11][12] Several investigators have proposed extended preoperative medical stabilization followed by delayed repair, but the results of such an approach in terms of overall outcome are controversial. [10][11][12] This report represents our experience with the management of 47 patients with congenital diaphragmatic hernia and analyzes the effect of preoperative stabilization on outcome. Patients and MethodsThis is a retrospective study of all patients admitted since 1982 to Tawam Hospital, Al-Ain, United Arab Emirates, with the diagnosis of congenital diaphragmatic hernia. The medical records of these patients were reviewed for age at presentation, sex, gestational age, birth weight, whether born at Tawam Hospital or referred from another hospital, associated anomalies, type and site of hernia, contents of the hernia, preoperative and postoperative management, blood gas parameters and outcome. The blood gases, as well as the alveolar arterial O 2 gradient (AaDO 2 =[173xFiO 2 ] -[PaCO 2 /0.8] -PaO 2 ) were analyzed in terms of outcome. The effect of preoperative stabilization, as well as changes in blood gas parameters, were also analyzed using Student's t-test. In the stabilized group, surgery was delayed in an attempt to achieve a pH of more than 7.2, PO 2 of greater than 50 torr, and PCO 2 of less than 50 torr.After evaluation at the Intensive Care Unit, endotracheal intubation was performed when indicated, and the patients were ventilated, using positive pressure ventilation (PPV) to start with, and positive end expiratory pressure (PEEP). Chest and abdominal x-rays were obtained, and respiratory support, as well as the ventilatory settings, were adjusted according to the blood gas estimates, which were obtained via umbilical and/or radial arterial catheters. Bowel decompression was achieved by nasogastric aspiration. All ventilated infants were paralyzed, and volume expanders as well as dopamine were used when indicated to maintain their blood pressure. Talozoline, surfactant, nitric oxide and dexamethasone were not used in any of our patients, and metabolic acidosis was corrected with bicarbonate therapy.All operations were performed by a transverse upper abdominal incision. After reducing the contents, primary closure of the diaphragmatic defect was performed and prosthetic graft was used whenever primary repair without tension could not be achieved. ResultsFrom 1982 to 1997, a total of 47 cases of congenital diaphragmatic hernia were admitted to our hospital. There were three cases of M...

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Improvement in survival of patients with congenital diaphragmatic hernia utilizing a strategy of delayed repair after medical and/or extracorporeal membrane oxygenation stabilization

Cited by 79 publications

References 13 publications

The long-term follow-up of patients with a congenital diaphragmatic hernia: a broad spectrum of morbidity

The long-term follow-up of patients with a congenital diaphragmatic hernia: a broad spectrum of morbidity

Predictors of Mortality and Morbidity in Infants with CDH

Congenital Diaphragmatic Hernia: The Impact of Preoperative Stabilization on Outcome

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