Timing of repair of congenital diaphragmatic hernia requiring extracorporeal membrane oxygenation support

Sigalet, David L.; Tierney, Anne J.; Adolph, Vincent R.; Perreault, Thérèse; Finer, Neil N.; Hallgren, Robert A.; Laberge, Jean-Martin

doi:10.1016/0022-3468(95)90017-9

Cited by 52 publications

(34 citation statements)

References 13 publications

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“…20 In contrast, the mortality for infants being referred to a specialized referral center with ECMO facilities is frequently reported at 40% or lower. [21][22][23][24][25][26][27][28][29][30][31][32] The wide range of outcomes presented, even for the same stage of fetal or infant life, further reflects the influence of center referral policies, publication bias, and management variation. The result is that information available to assist clinicians when counselling parents is often difficult to interpret and confusing.…”

Section: Introductionmentioning

confidence: 99%

Outcome of congenital diaphragmatic hernia

Beresford

Shaw

2000

Pediatr. Pulmonol.

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The outcome of congenital diaphragmatic hernia (CDH) differs for different stages of the fetus or infant's life (i.e., antenatal, immediate postnatal, and postoperative). Assessing combined data from nonrandomized studies is technically difficult. Following recognized methods of reviewing such trials, we aimed to review the available literature on the outcome of CDH to provide a guide to clinicians when counselling parents who have a fetus/infant with this condition. Thirty‐five studies reporting data for CDH from 1985 to March 1998 were identified using a high sensitive search strategy, hand‐searching journals, and reviewing references of relevant studies. These were systematically reviewed. The median overall mortality was 58% (interquartile range (IQR), 43–65%) for babies diagnosed in utero, 48% (IQR, 35–55%) if born alive, and 33% (IQR, 18–54%) postoperatively. Diagnosis before 25 weeks of gestation is not a uniformly bad prognostic indicator (median mortality, 60%). Outcome was worse for those fetuses with other anomalies (median mortality, 93%). The median percentage mortality for all infants born alive and treated in extracorporeal membrane oxygenation (ECMO) centers was 34% (IQR, 26–47%). Median percentage mortality for all ECMO‐treated infants was 44% (IQR, 35–50%). Different treatment strategies may have a variable impact on outcome. These figures, together with local data, may help in parental counselling on prognosis for fetuses/infants with CDH. Pediatr Pulmonol. 2000; 30:249–256. © 2000 Wiley‐Liss, Inc.

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Section: Introductionmentioning

confidence: 99%

Outcome of congenital diaphragmatic hernia

Beresford

Shaw

2000

Pediatr. Pulmonol.

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“…Overall mortality has been reported to be 35%. However, mortality can be as high as 50% in high-risk cases, 7 those described as having respiratory symptoms within 6 h after birth. 6 Although patients who do not require ECMO have a nearly 100% survival rate, 8 those treated with ECMO have particularly high risk of mortality and long-term morbidity.…”

Section: Introductionmentioning

confidence: 99%

“…6 Although patients who do not require ECMO have a nearly 100% survival rate, 8 those treated with ECMO have particularly high risk of mortality and long-term morbidity. [7][8][9][10] There has been much research aimed at isolating reliable predictive factors for survival in babies with CDH. Previous studies have evaluated both demographic and clinical data.…”

Section: Introductionmentioning

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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“…Patients requiring treatment with ECMO have a particularly high risk of mortality and long-term morbidity [3,[5][6][7] . Tools that enable clinicians to risk-stratify patients early may be important in directing therapy, particularly in high-risk cases requiring ECMO life support.…”

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confidence: 99%

Survival in Congenital Diaphragmatic Hernia: Use of Predictive Equations in the ECMO Population

Hoffman

Massaro²,

Gingalewski

et al. 2010

Neonatology

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Background: Equations have been proposed by the Wilford Hall/Santa Rosa (WHSR) and Congenital Diaphragmatic Hernia Study Group (CDHSG) for predicting survival in patients with CDH. The CDHSG stratifies risk based on a logistic regression equation incorporating birth weight and 5-min Apgar score, while the WHSR group uses the difference between maximum pO₂ and maximum pCO₂ as an index of risk. These models have not been applied specifically to the CDH ECMO (extracorporeal membrane oxygenation) population, a group at highest mortality risk. Objectives: To evaluate the WHSR and CDHSG predictive equations when applied to a population of patients with CDH requiring ECMO life support. Methods: A single-center retrospective review was conducted on infants with CDH treated with ECMO between 1993 and 2007. Predicted and actual outcomes were compared using receiver operating curve (ROC) analyses in which an area under the curve (AUC) of 1 denotes 100% agreement between predicted and actual outcomes. Kaplan-Meier analyses were also used to compare survival of patients who were risk-categorized according to each prediction model. Minimum pre-ECMO pCO₂ was likewise evaluated as a predictor of survival. Results: Overall survival was 50% in 62 CDH patients treated with ECMO during the study period. The CDHSG equation did not discriminate between survivors and nonsurvivors (AUC 0.55, p = 0.499). The modified WHSR formula showed better discrimination of survival (AUC 0.71, p = 0.004). Lowest achievable pre-ECMO pCO₂ had the highest AUC (0.723, p = 0.003). Patients with minimum pre-ECMO pCO₂ <50 mm Hg had 56% survival, while those with >70 mm Hg had 0% survival. Conclusions: Equations proposed to predict survival in CDH patients may not discriminate survivors from nonsurvivors in the ECMO population. In this highest risk group, factors such as birth weight and Apgar score are less critical in estimating mortality risk than indicators of ventilation and oxygenation that reflect the degree of pulmonary hypoplasia.

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Timing of repair of congenital diaphragmatic hernia requiring extracorporeal membrane oxygenation support

Cited by 52 publications

References 13 publications

Outcome of congenital diaphragmatic hernia

Outcome of congenital diaphragmatic hernia

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

Survival in Congenital Diaphragmatic Hernia: Use of Predictive Equations in the ECMO Population

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