IMPROVING SURVIVAL FOR PATIENTS WITH HIGH-RISK CONGENITAL DIAPHRAGMATIC-HERNIA BY USING EXTRACORPOREAL MEMBRANE-OXYGENATION

The benefit of extracorporeal membrane oxygenation (ECMO) in cases of high-risk congenital diaphragmatic hernia (CDH) was studied by compari ng pre-ECMO (1987-1990) and post-ECMO (1991-1994) 3-month survival sta tistics. Fifty-five CDH patients who presented in respiratory distress within 6 hours after birth were referred-18 in the pre-ECMO era and 3 7 in the ECMO era. During the entire study period (December 1987 throu gh July 1994) the patients were treated by the same protocol of preope rative stabilization and delayed surgery; the only difference was the addition of ECMO beginning in January 1991, The patients were stratifi ed based on the response to conventional treatment: 1, no response (ir retrievable); 2, stable; 3, unstable. The 3-month survival rate for th e unstable neonates (who could not be stabilized by conventional thera py) improved from 0% (0 of 9) in the pre-ECMO era to 61% (11 of 18) in the ECMO era (P = .004), This highly significant difference shows tha t ECMO is a very valuable addition to the management of high-risk CDH patients whose conditions remain unstable despite maximal conventional therapy. Copyright (C) 1995 by W.B. Saunders Company.