CARDIAC-ARREST BEFORE REPAIR OR EXTRACORPOREAL MEMBRANE-OXYGENATION CANNULATION DOES NOT INCREASE THE MORTALITY-RATE ASSOCIATED WITH CONGENITAL DIAPHRAGMATIC-HERNIA

Despite recent advances in the management of high-risk congenital diap hragmatic hernia (CDH), mortality remains high. Deaths occur later bec ause infants with inadequate pulmonary parenchyma are treated aggressi vely but eventually succumb to respiratory failure. In an attempt to i dentify absolute predictors of mortality the authors examined retrospe ctively their experience with CDH to determine if cardiac arrest befor e repair or initiation of extracorporeal membrane oxygenation (ECMO) i nvariably increased mortality. The authors reviewed the charts of 119 infants who had high-risk CDH treated between 1981 and 1994. They were divided into two groups: those that suffered cardiopulmonary arrest ( CA, n = 21) before CDH repair or ECMO cannulation; and those that did not (NCA, N = 98). The authors compared mortality rate, ventilatory pa rameters, duration of, and complications on ECMO, as well as length of hospitalization between groups. Twenty-one infants suffered CA before initiation of ECMO support or CDH repair. Three infants (14%) suffere d CA before arrival at our institution; seven (33%) after, and 11 (53% ) both before and after arrival. There was no difference between the C A and NCA groups in terms of birth weight, gestational age, race and g ender mix, or pregnancy and delivery complications. Five-minute Apgar scores were significantly lower in the CA group compared with the NCA group (4.6 v 5.7, P = .04). The CA group also had significantly worse ''best postductal'' blood gas and ventilatory parameters. There was no significant difference in length of hospitalization, time from admiss ion to ECMO cannulation or CDH repair, or incidence of complications w hile on ECMO between the two groups. CA cases were more likely to requ ire ECMO support (76% v 48%, P = .02) and to stay on ECMO for a more p rolonged period than NCA cases (5.8 v 3.8 days, P = NS). However, ther e was no significant difference in overall survival between CA and NCA cases (43% v 51%, P = NS). Cardiopulmonary arrest before repair of CD H or ECMO cannulation is not a univariate independent predictor of mor tality and therefore should not preclude these highrisk infants from m aximum intensive care therapy, including ECMO cannulation. Copyright ( C) 1997 by W.B. Saunders Company.