ECMO in CDH: Is there a role?

• Published in: Seminars in pediatric surgery Vol. 26; no. 3; pp. 166 - 170
• Main Author: Kays, David W., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2017
• Subjects: Combined Modality Therapy; Congenital diaphragmatic hernia; ECMO; Extracorporeal Membrane Oxygenation - adverse effects; Extracorporeal Membrane Oxygenation - methods; Extracorporeal Membrane Oxygenation - mortality; Hernias, Diaphragmatic, Congenital - mortality; Hernias, Diaphragmatic, Congenital - therapy; Herniorrhaphy; Humans; Infant, Newborn; Pediatrics; Pulmonary hypoplasia; Repair; Surgery; Survival; Survival Rate; Treatment Outcome; ECMO; Pulmonary hypoplasia; Congenital diaphragmatic hernia; Repair; Survival
• ISSN: 1055-8586; 1532-9453
• DOI: 10.1053/j.sempedsurg.2017.04.006

Abstract Despite its wide use, survival in congenital diaphragmatic hernia (CDH) patients treated with Extracorporeal Membrane Oxygenation (ECMO), as reported by the Extracorporeal Life Support Organization (ELSO), remains unchanged at 50%. High survival rates both with and without utilizing ECMO have been reported, fueling questions about the utility of ECMO support in this difficult population. This review looks at data from the Congenital Diaphragmatic Hernia study group and individual center reports, to evaluate the role of ECMO in CDH, focusing on defining the patients most likely to benefit, and discussing how those benefits can best be achieved. These data show that ECMO improves survival in those CDH patients most severely affected, but potential complications of ECMO delivery outweigh benefit in patients less severely affected. Improved results can be expected by minimizing ECMO complications, and by improving rates of CDH repair in patients that require ECMO.