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

Tiruvoipati, Ravindranath; Vinogradova, Yana; Faulkner, Gail; Sosnowski, Andrzej; Firmin, Richard K.; Peek, Giles J.

doi:10.1016/j.jpedsurg.2007.03.031

Cited by 48 publications

(33 citation statements)

References 22 publications

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“…The association between prolonged duration of ECMO and mortality has been previously noted [28,29]. Stevens et al [27] suggested that longer duration of ECMO may lead to multiple complications including renal, hematological, and CNS complications.…”

Section: Discussionmentioning

confidence: 97%

“…Several authors have proposed predictors for outcomes in children with CDH [11,[15][16][17][18][19][20][21][22][23][24][25]. Reliable mortality predictors specific to neonates with CDH assessing both pre-ECMO and on-ECMO factors are limited [27][28][29], and no mortality prediction score applicable to this population is available in the literature. The difficulty in generating an equation that accurately predicts outcomes highlights the complexity of the condition.…”

Section: Discussionmentioning

confidence: 99%

“…Several authors have addressed factors influencing survival or mortality in children requiring ECMO management [26][27][28][29]. Three of these studies [27][28][29] assessed both pre-ECMO and on-ECMO factors associated with survival using logistic regression and report odds ratio estimates. Although odds ratios are perfectly valid, it is known that in situations where the outcome is not "rare," odds ratio tends to overestimate the underlying relative risk [30,31].…”

mentioning

confidence: 99%

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

Haricharan

Barnhart

Cheng

et al. 2009

Journal of Pediatric Surgery

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Haricharan

Barnhart

Cheng

et al. 2009

Journal of Pediatric Surgery

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“…Recently, Tiruvoipati et al 30 similarly reviewed their singlecenter experience in CDH ECMO patients and did not find a pre-ECMO ventilatory parameter that differentiated survivors from non-survivors. Our study differs in that we explored minimum and maximum values of the respiratory parameters in addition to mean values.…”

Section: Discussionmentioning

confidence: 99%

Predictors of survival in congenital diaphragmatic hernia patients requiring extracorporeal membrane oxygenation: CNMC 15-year experience

et al. 2010

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Objective: To review outcomes of patients with congenital diaphragmatic hernia (CDH) requiring extracorporeal membrane oxygenation (ECMO) at a level IIIC neonatal intensive care unit and to determine if pre-ECMO respiratory status can help predict mortality.Study Design: A single-center retrospective chart review was conducted on all infants with CDH treated with ECMO in the past 15 years. Demographic and clinical information, including pre-ECMO ventilatory and blood gas data, was collected. Differences between survivors and nonsurvivors were evaluated using independent samples t-/Mann-Whitney U-and Fisher's exact/w 2 -tests for continuous and categorical data, respectively. Cox regression analysis was performed to evaluate predictors of survival while controlling for covariates. Significant predictors were further explored with receiver operating characteristic (ROC) curve and Kaplan-Meier survival analysis.Result: Overall survival of the population of 62 patients treated with ECMO was 50%. Survivor and non-survivors were similar in birth weight, gestational age, gender, race and Apgar scores. Approximately 80% of patients in both groups had a left-sided defect. Less than half of patients were prenatally diagnosed in either group. Patients in the non-survivor group had associated anomalies (42 vs 23% for survivors) but this was not statistically significant (P ¼ 0.303). Non-survivors were more likely to be put on ECMO earlier, stay on ECMO longer and be operated upon later. On pre-ECMO blood gas analyses, survivors had higher pH and PaO 2 , and lower oxygenation index and PaCO 2 compared with non-survivors. After controlling for covariates, a lower minimum PaCO 2 and side of defect were the only independent predictors of survival. ROC curve for minimum pre-ECMO PaCO 2 had a significant area under the curve (0.72, P ¼ 0.003). Survival was 27% in babies unable to achieve a pre-ECMO PaCO 2 <60 mm Hg whereas no patients survived if their lowest pre-ECMO PaCO 2 was >70 mm Hg. Conclusion:Minimum achievable pre-ECMO PaCO 2 is an independent predictor of survival in patients with CDH requiring ECMO life support. These data provide useful prognostic information for counseling families and may facilitate direction of care in extreme cases where the degree of pulmonary hypoplasia may be incompatible with life.

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“…Beyond two weeks of ECMO support, survival decreases significantly (Tiruvoipati et al, 2007;Seetharamaiah et al, 2009). This could be related to increased renal, hematological, and CNS complications (Stevens et al 2002).…”

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

Cited by 48 publications

References 22 publications

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

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

Predictors of survival in congenital diaphragmatic hernia patients requiring extracorporeal membrane oxygenation: CNMC 15-year experience

Predictors of Mortality and Morbidity in Infants with CDH

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