Lung size and liver herniation predict need for extracorporeal membrane oxygenation but not pulmonary hypertension in isolated congenital diaphragmatic hernia: systematic review and meta‐analysis

Russo, Francesca Maria; Eastwood, Marie P; Keijzer, Richard; Almaary, Jamila; Toelen, Jaan; Mieghem, Tim Van; Deprest, Jan

doi:10.1002/uog.16000

Cited by 78 publications

(66 citation statements)

References 75 publications

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“…Total lung volume in patients with CDH is significantly smaller to that of controls, and the antenatal identification of severe lung hypoplasia can be a significant determinant of postnatal course and the need for ECMO 1. Reduced surface area available for gas exchange causes severe hypoxaemia and hypercarbia, and is one of the main pathological abnormalities that can determine the consideration of ECMO.…”

Section: Pathophysiology In Cdh and The Need For Ecmomentioning

confidence: 99%

“…Therefore, as yet, there are no known antenatal markers which predict the degree of PPHN in CDH. Indeed, there is no correlation between lung volume and development of PPHN 1. Therefore, patients with either good or bad prognostication based on antenatal lung volumes and ratios can have a discrepant clinical course.…”

Section: Pathophysiology In Cdh and The Need For Ecmomentioning

confidence: 99%

“…The presence of liver herniation is associated with the need for ECMO1; it has also been suggested that early repair of left liver-up CDH before ECMO may result in improved survival 33. Using multivariate models to assess risk for ECMO at 1 hour of life, 95% repaired in the first 60 hours and before institution of ECMO survived; whereas of those who had ECMO before CDH repair, only 65% survived.…”

Section: Indications For and Outcome Of Ecmomentioning

confidence: 99%

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Role of ECMO in congenital diaphragmatic hernia

McHoney

Hammond

2017

Arch Dis Child Fetal Neonatal Ed

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Congenital diaphragmatic hernia (CDH) is typified morphologically by failure of diaphragmatic development with accompanying lung hypoplasia and persistent pulmonary hypertension of the newborn (PPHN). Patients who have labile physiology and low preductal saturations despite optimal ventilatory and inotropic support may be considered for extracorporeal membrane oxygenation (ECMO). Systematic reviews into the benefits of ECMO in CDH concluded that any benefit is unclear. Few randomised trials exist to demonstrate clear benefit and guide management. However, ECMO may have its uses in those that have reversibility of their respiratory disease. A few centres and networks have demonstrated an increase in survival rate by post hoc analysis (based on a difference in referral patterns with the availability of ECMO) in their series. One issue may be that of careful patient selection with regard to reversibility of pathophysiology. At present, there is no single test or prognostication that predicts reversibility of PPHN and criteria for referral for ECMO is undergoing continued refinement. Overall survival is similar between cannulation modes. There is no consensus on the time limit for ECMO runs. The optimal timing of surgery for patients on ECMO is difficult to definitively establish, but it seems that repair at an early stage (with careful perioperative management) is becoming less of a taboo, and may improve outcome and help with either coming off ECMO or decisions on withdrawal later. The provision of ECMO will continue to be evaluated, and prospective randomised trial are needed to help answer question of patient selection and management.

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Section: Pathophysiology In Cdh and The Need For Ecmomentioning

confidence: 99%

Section: Pathophysiology In Cdh and The Need For Ecmomentioning

confidence: 99%

Section: Indications For and Outcome Of Ecmomentioning

confidence: 99%

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Role of ECMO in congenital diaphragmatic hernia

McHoney

Hammond

2017

Arch Dis Child Fetal Neonatal Ed

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“…Others report that lung size and liver herniation predict the need for ECMO but do not predict pulmonary hypertension [18].…”

Section: Fetal Mri Consistent With a Low Lung Volumementioning

confidence: 99%

Congenital Diaphragmatic Hernia

2018

Imaging in Pediatrics

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Despite advances in neonatal and surgical care, the management of congenital diaphragmatic hernia (CDH) remains challenging with no definitive standard treatment guidelines. Several centers report mortality rates as low as 20%, but if extracorporeal membrane oxygenation (ECMO) support is required, the mortality rate rises to 50%. The disease severity is related to the degree of pulmonary hypoplasia and pulmonary hypertension that occurs with CDH. Both conditions decrease the infant's ability to ventilate and oxygenate adequately at delivery. These physiologic conditions that impair gas exchange are the important determinants of morbidity and mortality in CDH infants. Presently, delivery of infants with CDH is recommended close to term gestation. The focus of care includes gentle ventilation, hemodynamic monitoring, and treatment of pulmonary hypertension followed by surgery for the defect. Extracorporeal membrane oxygenation (ECMO) is considered after failure of conventional medical management for infants ≥ 34 weeks' gestation or with weight >2 kg and no associated major lethal anomalies. This chapter discusses long-term follow-up recommendations for survivors, which should involve a multidisciplinary approach, as there are many surgical and nonsurgical consequences to the disease process. Clinical strategies that address these multifaceted aspects of care, from prenatal to long-term follow-up, may further reduce the high mortality rate for these infants.

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“…According to some papers, there might be a strong association between neonatal death, ECMO (extracorporeal membrane oxygenation) requirement and short-term respiratory morbidity, depending on the position of the fetal stomach [24]. According to Russo et al, the need for ECMO may be predicted based on lung size and liver herniation [26].…”

Section: Prognostic Factorsmentioning

confidence: 99%

Congenital diaphragmatic hernia: pathogenesis, prenatal diagnosis and management — literature review

Kosiński

Wielgoś

2017

Ginekol Pol

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Congenital diaphragmatic hernia (CDH) is a developmental discontinuity of the diaphragm. It allows abdominal viscera to herniate into the chest and leads to lung hypoplasia. Congenital diaphragmatic hernia is one of the most severe birth defects, with extremely high neonatal mortality. This paper presents a review of the available literature on prenatal diagnosis, management and treatment options for CDH. In selected cases, a prenatal procedure to improve neonatal survival is possible. The authors of this manuscript believe their work might contribute to a better understanding of congenital diaphragmatic hernia and patient selection for the FETO (fetal endoscopic tracheal occlusion) surgery or expectant management.

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Lung size and liver herniation predict need for extracorporeal membrane oxygenation but not pulmonary hypertension in isolated congenital diaphragmatic hernia: systematic review and meta‐analysis

Abstract: Objectives To identify antenatal predictors of persistent pulmonary hypertension (PPH) and the need for extracorporeal membrane oxygenation (ECMO) in fetuses with congenital diaphragmatic hernia (CDH). Methods (RR, 3.04 (95% CI,

Cited by 78 publications

References 75 publications

Role of ECMO in congenital diaphragmatic hernia

Role of ECMO in congenital diaphragmatic hernia

Congenital Diaphragmatic Hernia

Congenital diaphragmatic hernia: pathogenesis, prenatal diagnosis and management — literature review

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