Management of Congenital Diaphragmatic Hernia Treated With Extracorporeal Life Support: Interim Guidelines Consensus Statement From the Extracorporeal Life Support Organization

Guner, Yigit S.; Jancelewicz, Tim; Nardo, Matteo Di; Yu, Peter T.; Brindle, Mary; Vogel, Adam M.; Gowda, Sharada H.; Grover, Theresa R.; Johnston, Lindsay; Mahmood, Burhan; Gray, Brian W.; Chapman, Rachel; Keene, Sarah; Rintoul, Natalie E.; Cleary, John P.; Ashrafi, Amir H; Harting, Matthew T.

doi:10.1097/mat.0000000000001338

Cited by 44 publications

(25 citation statements)

References 39 publications

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“…However, even considering the severely detrimental conditions in patients with CDH requiring ECMO, a 50% survival rate is suboptimal. Efforts have been made to improve the outcomes by standardizing the management, involving a multidisciplinary team, and individualizing the treatment [3]. In this study that used single-center data from the start of the ECMO program for CDH in 2008, the overall rate of successful weaning from ECMO was 45.1% and the hospital survival rate was 31.4%.…”

Section: Discussionmentioning

confidence: 98%

“…CDH is the most common indication for ECMO in cases of neonatal respiratory failure in the ELSO database. However, patients with CDH requiring ECMO continue to have the lowest rate of survival to discharge (50%) compared with those with other indications, such as meconium aspiration syndrome (93%) or persistent pulmonary hypertension of newborns (74%) [3,4]. This is attributable to the change in the risk profile of patients with CDH requiring ECMO, which is a high-risk group that has shown a greater tendency than other groups to undergo ECMO in recent years [5].…”

Section: Discussionmentioning

confidence: 99%

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Outcomes after Extracorporeal Membrane Oxygenation in Neonates with Congenital Diaphragmatic Hernia: A Single-Center Experience

et al. 2021

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Background: Congenital diaphragmatic hernia (CDH) is a rare disease often requiring mechanical ventilation after birth. In severe cases, extracorporeal membrane oxygenation (ECMO) may be needed. This study analyzed the outcomes of patients with CDH treated with ECMO and investigated factors related to in-hospital mortality. Methods: Among 254 newborns diagnosed with CDH between 2008 and 2020, 51 patients needed ECMO support. At Asan Medical Center, a multidisciplinary team approach has been applied for managing newborns with CDH since 2018. Outcomes were compared between hospital survivors and nonsurvivors. Results: ECMO was established at a median of 17 hours after birth. The mean birth weight was 3.1±0.5 kg. Twenty-three patients (23/51, 45.1%) were weaned from ECMO, and 16 patients (16/51, 31.4%) survived to discharge. The ECMO mode was veno-venous in 24 patients (47.1%) and veno-arterial in 27 patients (52.9%). Most cannulations (50/51, 98%) were accomplished through a transverse cervical incision. No significant between-group differences in baseline characteristics and prenatal indices were observed. The oxygenation index (1 hour before: 90.0 vs. 51.0, p=0.005) and blood lactate level (peak: 7.9 vs. 5.2 mmol/L, p=0.023) before ECMO were higher in nonsurvivors. Major bleeding during ECMO more frequently occurred in nonsurvivors (57.1% vs. 12.5%, p=0.007). In the multivariate analysis, the oxygenation index measured at 1 hour before ECMO initiation was identified as a significant risk factor for in-hospital mortality (odds ratio, 1.02; 95% confidence interval, 1.01-1.04; p=0.05). Conclusion:The survival of neonates after ECMO for CDH is suboptimal. Timely application of ECMO is crucial for better survival outcomes.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Outcomes after Extracorporeal Membrane Oxygenation in Neonates with Congenital Diaphragmatic Hernia: A Single-Center Experience

et al. 2021

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“…In the registry of isolated LCDH, the survival rate was reported based on the O/E LHR interval (15, 25, 35, and 45%) along with the presence of liver herniation [ 25 ]. A recent ECMO guideline for CDH proposed a prenatal risk stratification system, which includes an O/E LHR cut-off value of < 25%, liver herniation, and the O/E total lung volume [ 30 ]. However, it remains unclear whether such a graded classification can be used for RCDH.…”

Section: Discussionmentioning

confidence: 99%

Prenatal prognostic factors for isolated right congenital diaphragmatic hernia: a single center’s experience

et al. 2021

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Background Right-sided congenital diaphragmatic hernia (RCDH) is relatively rare compared with left-sided congenital diaphragmatic hernia (LCDH). Clinical data of RCDH, especially with respect to antenatal prediction of neonatal outcome, are lacking. The aim of this study was to report the treatment outcomes of patients with antenatally diagnosed RCDH and to evaluate the predictability of observed-to-expected lung area-to-head circumference ratio (O/E LHR) for perinatal outcomes, focused on mortality or extracorporeal membrane oxygenation (ECMO) requirement. Methods We retrospectively reviewed the medical records of newborn infants with isolated RCDH. We analyzed and compared the clinical and prenatal characteristics including the fetal lung volume, which was measured as the O/E LHR, between the survivors and the non-survivors. Results A total of 26 (66.7%) of 39 patients with isolated RCDH survived to discharge. The O/E LHR was significantly greater in survivors (64.7 ± 21.2) than in non-survivors (40.5 ± 23.4) (P =.027). It was greater in survivors without ECMO requirement (68.3 ± 15.1) than non-survivors or those with ECMO requirement (46.3 ± 19.4; P = .010). The best O/E LHR cut-off value for predicting mortality in isolated RCDH was 50. Conclusions The findings in this study suggest that O/E LHR, a well-characterized prognostic indicator in LCDH, could be applied to a fetus with antenatally diagnosed RCDH. A large cohort study is required to verify the association between O/E LHR values and the graded severity of RCDH.

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“…lower in V-V support as compared to V-A support, although factors other than just the cannulation may account for this (3,8).…”

mentioning

confidence: 88%

“…However, it should be noted that mortality is not significantly different between the two types of support. However, neurological complications are reported to be lower in V-V support as compared to V-A support, although factors other than just the cannulation may account for this ( 3 , 8 ).…”

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confidence: 99%

Editorial: Neonatal ECMO in 2019: Where Are We Now? Where Next?

et al. 2022

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Editorial on the Research TopicNeonatal ECMO in 2019: Where Are We Now? Where Next? Despite significant advances in neonatal intensive care, including neonatal ventilation in the current era, extracorporeal membrane oxygenation (ECMO) continues to play a crucial role in selected cases of severe cardio-respiratory failure, potentially reversible, but refractory to conventional ventilatory therapy and maximal pharmacological treatment (1).Our Research Topic attempted to focus on some of continuing challenges in neonatal ECMO. In this issue of Frontiers in Pediatrics, we have collected a wide range of manuscripts related to the use of ECMO in the neonatal period (Broman; Butt and Chiletti; Cashen et al.; Di Nardo et al.; Kersten et al.; Macchini et al.; Perez Ortiz et al.; Rafat and Schaible; Raffaeli et al.; Raffaeli et al.; Roeleveld and Mendonca; Schiller and Tibboel).Since the formation of the Extracorporeal Life Support Organization (ELSO) in 1989, 45,205 newborns have been supported on ECMO in 492 centers (www.elso.org) (2). Respiratory failure was the predominant reason for ECMO utilization in 33,400 newborns, whereas ECMO was used for cardiac failure in 9,561 newborns, and 2,244 were supported for refractory cardiac arrest-extracorporeal cardiopulmonary resuscitation (ECPR). Today, congenital diaphragmatic hernia (CDH) and meconium aspiration syndrome (MAS) are the exclusive neonatal diagnoses that alone represent about 46% of all cases of neonatal respiratory ECMO, reaching 92% of total ECMO if all "others" neonatal ECMO were added (2, 3). The classification of "others" includes all other diagnostic categories such as non-specific respiratory failure, congenital anomaly, pulmonary hypoplasia, hypoxic-ischemic encephalopathy, cardiorespiratory arrest, and inborn errors of metabolism (4). The mortality rate, however, varies significantly depending on the underlying respiratory disease. For instance, neonates with CDH and sepsis have higher mortality rates (47 and 49%, respectively) in contrast to those with MAS (9%) (2). Pulmonary hypertension and lung hypoplasia play a crucial role in determining survival in CDH (5). Neonates with prolonged ECMO run for >21 days have demonstrated higher mortality due to the increased risk of mechanical complications (6).Veno-arterial (V-A) ECMO still represents the support of choice in neonates, with more than 80% receiving V-A support (2). The vessel size is the most critical limiting factor in using the veno-venous (V-V) ECMO in neonates as the smallest double-lumen venous cannula currently commercially available is 13 Fr (3, 7). However, it should be noted that mortality is not significantly different between the two types of support. However, neurological complications are reported to be

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Management of Congenital Diaphragmatic Hernia Treated With Extracorporeal Life Support: Interim Guidelines Consensus Statement From the Extracorporeal Life Support Organization

Cited by 44 publications

References 39 publications

Outcomes after Extracorporeal Membrane Oxygenation in Neonates with Congenital Diaphragmatic Hernia: A Single-Center Experience

Outcomes after Extracorporeal Membrane Oxygenation in Neonates with Congenital Diaphragmatic Hernia: A Single-Center Experience

Prenatal prognostic factors for isolated right congenital diaphragmatic hernia: a single center’s experience

Editorial: Neonatal ECMO in 2019: Where Are We Now? Where Next?

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