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Reversal of mortality for congenital diaphragmatic hernia with ECMO. Ann Surg 1989 Feb;209(2):225-30 PMID: 2644900 PMCID: PMC1493900

Pubmed ID

2644900

Abstract

Extracorporeal Membrane Oxygenation (ECMO) has been available to neonates with respiratory failure at the University of Michigan School of Medicine since June 1981. In order to evaluate the impact of this type of pulmonary support, a retrospective analysis of 50 neonates with posterolateral congenital diaphragmatic hernia (CDH) who were symptomatic during the first hour of life and were treated between June 1974 and December 1987 was carried out. The patients were divided into two groups, those treated before June 1981 (16 patients) and those treated after June 1981 (34 patients). Overall survival improved from 50% (eight of 16 patients) during the pre-ECMO era to 76% (26 of 34 patients) during the post-ECMO period (p = 0.06). During the period after June 1981, 21 neonates were unresponsive to conventional therapy and were therefore considered for ECMO. Failure of conventional therapy was defined as acute clinical deterioration with an expected mortality of greater than 80% based on an objective formula previously reported. Six patients were excluded on the basis of specific contraindications to ECMO. Thirteen of 15 infants (87%) supported with ECMO survived. Three patients treated before 1981 met criteria for ECMO; all three died while receiving treatment using conventional therapy. These survival differences are significant (p less than 0.01). In addition, the survival of 87% for the infants treated with ECMO versus the expected mortality of greater than 80% for these same patients when treated with conventional therapy is highly significant (p less than 0.005). Based on this data, ECMO appears to be a successful, reliable, and safe method of respiratory support for selected, critically ill infants with CDH.

Author List

Heiss K, Manning P, Oldham KT, Coran AG, Polley TZ Jr, Wesley JR, Bartlett RH

Author

Keith T. Oldham MD Professor in the Surgery department at Medical College of Wisconsin




Scopus

2-s2.0-0024502360   91 Citations

MESH terms used to index this publication - Major topics in bold

Evaluation Studies as Topic
Extracorporeal Membrane Oxygenation
Hernia, Diaphragmatic
Hernias, Diaphragmatic, Congenital
Humans
Infant, Newborn
Length of Stay
Michigan
Respiratory Distress Syndrome, Newborn
Retrospective Studies
jenkins-FCD Prod-310 bff9d975ec7f2d302586822146c2801dd4449aad