Neonatal congenital diaphragmatic hernia and extracorporeal membrane oxygenation

Abstract

Objective: To describe the outcome of infants with congenital diaphragmatic hernia (CDH) presenting early who were referred for possible extracorporeal membrane oxygenation (ECMO).

Design: Retrospective descriptive study.

Setting: Neonatal Intensive Care Unit of the Royal Alexandra Hospital, Edmonton.

Patients: Fifteen infants referred to our program since its introduction, in February 1989; 13 received ECMO. The criterion for ECMO was the presence of an oxygen index of more than 40 on three occasions within 2 hours.

Intervention: ECMO was performed by means of cannulation of the right carotid artery and jugular vein for 111.0 hours on average.

Results: In 5 of the 13 infants who underwent ECMO the procedure was performed after surgical repair; all were successfully weaned off ECMO, and the cannula was removed without incident. In the remaining eight ECMO was started before surgical repair; of the six who received it during repair four ultimately survived. None of the previously described predictors of outcome for CDH, including diagnosis before 25 weeks' gestation (in six cases), were useful in determining the survival of the patients. Bleeding was the most common complication and cause of death.

Conclusion: ECMO is associated with survival in infants with CDH who fail to respond to conventional therapy and who have a poor prognosis according to previously established criteria.