SURVIVAL OF PATIENTS WITH CONGENITAL DIAPHRAGMATIC-HERNIA DURING THE ECMO ERA - AN 11-YEAR EXPERIENCE

Background/Purpose: Congenital diaphragmatic hernia (CDH) is associate d with significant mortality and morbidity. To evaluate the impact of extracorporeal membrane oxygenation (ECMO) on survival, a review of ou r experience with CDH patients was initiated. Methods: The authors per formed a retrospective non randomized analysis of 98 consecutive CDH p atients who were ECMO candidates, and were symptomatic within the fi r st day of life, and underwent repair between May 1985 and May 1996. Th e patients were divided into three groups: Group 1 (n = 38) refers to patients who were clinically stable and underwent repair before 48 hou rs of age and did not need ECMO rescue; Group 2 (n = 29) consists of p atients who underwent repair but required ECMO rescue; and Group 3 (n = 31) refers to patients who met ECMO criteria preoperatively and requ ired ECMO for stabilization and later underwent repair on ECMO. The Ka plan-Meier survival graph was used for survival analysis. Results: Dur ing the Ii-year span, the overall survival rate of all CDH patients wa s 72% (71 of 98). The survival rate of patients who did not require EC MO support was 92% (35 of 38), whereas patients who required ECMO afte r repair had a 72% (21 of 29) survival rate. These were com pa red wit h a 48% ,(15 of 31) survival rate for those undergoing repair on ECMO. The differences in survival among the three groups were statistically significant using the log-rank test (P=.0018). Conclusions: Survival was significantly better for infants who underwent successful repair w ithout ECMO than those who required ECMO rescue pre-or postrepair. The overall improved survival of CDH patients to 72% compared with histor ical controls of 38% to 58% may be attributed to ECMO, but the require ment of ECMO before repair, as well as the presence of congenital anom alies (P<.01), prematurity (P<.01), the need for a Gore-Tex patch at r epair (P<.05), prenatal diagnosis at less than 25 weeks' gestation (P< .01), and the occurrence of an intracranial hemorrhage (P<.01), decrea ses the chances of survival.