ENTRY CRITERIA FOR EXTRACORPOREAL MEMBRANE-OXYGENATION IN NEONATES WITH CONGENITAL DIAPHRAGMATIC-HERNIA TREATED WITH HIGH-FREQUENCY OSCILLATORY VENTILATION

Although respiratory management with high-frequency oscillatory ventil ation (HFOV) has generally been used for neonates with congenital diap hragmatic hernia (CDH), entry criteria for extracorporeal membrane oxy genation (ECMO) based on data from patients who underwent HFOV have no t yet been reported. To establish entry criteria for ECMO in such pati ents, we retrospectively studied 36 neonates with CDH treated by HFOV in our institutions between 1986 and 1994. From the admission records, preductal and postductal arterial blood gas data and HFOV ventilation conditions for 72 h after admission were extracted. Oxygenation index (OI) and alveolar-arterial oxygen gradient (A-aDO(2)) time interval c ombinations were calculated. Patients were divided into two groups: ca ndidates for ECMO (n = 22) who underwent ECMO (n = 18) or died without ECMO (n = 4); and non-candidates (n = 14), who survived without ECMO. Blood gas data in patients placed on ECMO were comparable to those in patients who died without ECMO: mean pre- and postductal OI for 4 h > 30, postductal A-aDO(2) greater than or equal to 620 mmHg for 4 h, po stductal A-aDO(2) greater than or equal to 580 mmHg for 8 h, and postd uctal A-aDO(2) greater than or equal to 550 mmHg for 12 h showed bette r sensitivity with a specificity of more than 90% compared to entry cr iteria that had previously been used in our institutions: a postductal OI >40 for 4 h and postductal A-aDO(2) greater than or equal to 610 m mHg for 8 h. in addition, a combination of pre- and postductal OI >30 for 4 h indicated a sensitivity of 95.5% and a specificity of 92.9%.