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Congenital Diaphragmatic Hernia

Outcome of Preoperative Extracorporeal Membrane Oxygenation

The George Washington University School of Medicine and Children's National Medical Center, Washington, DC

Sandra T. Robbins

The George Washington University School of Medicine and Children's National Medical Center, Washington, DC

Vera L. Reed

The George Washington University School of Medicine and Children's National Medical Center, Washington, DC

David M. Powell

The George Washington University School of Medicine and Children's National Medical Center, Washington, DC

Billie L. Short

The George Washington University School of Medicine and Children's National Medical Center, Washington, DC

In recent years, increasing numbers of patients with congenital diaphragmatic hernia (CDH) have been offered extracorporeal membrane oxygenation (ECMO) preoperatively if they can not physiologically tolerate early surgical repair. These infants are sicker and more unstable than those repaired pre-ECMO and, in most cases, have not had a "honeymoon" period (i.e., PaO₂ >100 mm Hg at some point). ECMO before surgical repair was offered to 27 CDH patients in our institution; of the 16 (59%) survivors, 11 are now 2 years of age or older. To determine the outcome risk for this critical population, we compared 11 infants placed on ECMO pre-CDH repair (Group A) with our previous series of 22 survivors who had their surgery prior to ECMO (Group B). Both groups were similar in birth weight, gestational age, and Apgar scores. In Group A, a greater number were females (73% vs 23%), had right-sided hernia (64% vs 23%), and required patch repairs (82% vs 23%). The mean time on ECMO, time to extubation, and mean length of hospitalization were longer in group A. In both groups combined, the frequency of reherniation was higher in the patch-repair infants compared with those with a primary closure. Incidence of reflux was high in both groups, with increasing frequency of Nissen fundoplication in Group A patients (45% vs 6%). Both groups demonstrated similar delayed growth at 1 year of age. Although infants placed on ECMO presurgery are sicker, with more post-ECMO morbidity, their growth failure is similar to the less sick infants repaired pre-ECMO. Therefore, we recommend close followup of all CDH infants treated with ECMO in multidisciplinary follow-up clinics.

Clinical Pediatrics, Vol. 34, No. 9, 471-474 (1995)
DOI: 10.1177/000992289503400904


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