Do we use the right entry criteria for extracorporeal membrane oxygenation in congenital diaphragmatic hernia?

• Published in: Journal of pediatric surgery Vol. 28; no. 8; pp. 1003 - 1005
• Main Authors: Staak, F.H.J.vd, Thiesbrummel, A., de Haan, A.F.J., Oeseburg, B., Geven, W.B., Festen, C.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01.08.1993; Elsevier
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Emergency and intensive care: neonates and children. Prematurity. Sudden death; Extracorporeal Membrane Oxygenation; Female; Hernia, Diaphragmatic - mortality; Hernia, Diaphragmatic - therapy; Hernias, Diaphragmatic, Congenital; Humans; Hypertension, Pulmonary - congenital; Hypertension, Pulmonary - mortality; Hypertension, Pulmonary - therapy; Infant, Newborn; Intensive care medicine; Male; Medical sciences; Oxygen - physiology; Pulmonary Diffusing Capacity - physiology; Respiratory Distress Syndrome, Newborn - mortality; Respiratory Distress Syndrome, Newborn - therapy; Survival Rate; extracorporeal membrane oxygenation (ECMO); Congenital diaphragmatic hermia; Human; Membrane oxygenator; Prognosis; Congenital; Respiratory disease; Indication; Respiratory intensive care; Cardiopulmonary bypass; Hernia; Newborn diseases; Newborn; Diaphragm; Oxygenation; Resuscitation
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/0022-3468(93)90502-C

In a retrospective review we analysed alveolar-arterial oxygen difference (AaDO 2) as an entry criterion for extracorporeal membrane oxygenation (ECMO) in neonates with several forms of acute respiratory insufficiency. Although for meconium aspiration syndrome, respiratory distress syndrome, sepsis, and idiopathic pulmonary hypertension of the newborn we found values in accordance with the literature, patients with congenital diaphragmatic hernia (CDH) met 80% mortality criteria with significant lower AaDO 2 values. Several patients died before ever reaching usual entry criteria for ECMO, because serious lung deterioration makes AaDO 2 values unreliable. Awaiting classical ECMO entry criteria for patients with CDH may at least partially explain the lower survival rate for ECMO in CDH.