Selective use of extracorporeal membrane oxygenation in the management of congenital diaphragmatic hernia

Stolar, Charles J.H.; Dillon, Peter W.; Reyes, Cynthia

doi:10.1016/s0022-3468(88)80723-1

Cited by 108 publications

(22 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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.

View full text Add to dashboard Cite

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.

show abstract

Section: Introductionmentioning

confidence: 99%

Outcome of congenital diaphragmatic hernia

Beresford

Shaw

2000

Pediatr. Pulmonol.

View full text Add to dashboard Cite

show abstract

“…Some authors advocate utilizing clinical parameters and offering ECMO to any patient who can sustain a preductal oxygen saturation ≥90% for Herniaat least 1 hour, a PaO 2 of 100 on FiO 2 1.0 and at least one recorded PaCO 2 < 50 mmHg [45]. CDH infants with progressive hypoxemia who meet these initial criteria supported with ECMO have 85% survival to discharge [46].…”

Section: Selection Criteriamentioning

confidence: 99%

Congenital Diaphragmatic Hernia

M¹,

F²

2013

FRCR 2B Viva: A Case-Based Approach

View full text Add to dashboard Cite

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.

show abstract

“…Some authors advocate utilizing clinical parameters and ofering ECMO to any patient who can sustain a preductal oxygen saturation ≥90% for Herniaat least 1 hour, a PaO 2 of 100 on FiO 2 1.0 and at least one recorded PaCO 2 < 50 mmHg [45]. CDH infants with progressive hypoxemia who meet these initial criteria supported with ECMO have 85% survival to discharge [46].…”

Section: Selection Criteriamentioning

confidence: 99%

Congenital Diaphragmatic Hernia

1998

Key Topics in Neonatology

View full text Add to dashboard Cite

Despite advances in neonatal and surgical care, the management of congenital diaphragmatic hernia (CDH) remains challenging with no deinitive 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.

show abstract

Selective use of extracorporeal membrane oxygenation in the management of congenital diaphragmatic hernia

Cited by 108 publications

References 9 publications

Outcome of congenital diaphragmatic hernia

Outcome of congenital diaphragmatic hernia

Congenital Diaphragmatic Hernia

Congenital Diaphragmatic Hernia

Contact Info

Product

Resources

About