Extracorporeal Membrane Oxygenation in Neonates with Congenital Diaphragmatic Hernia: a Preliminary Experience

ABSTRACT

Extracorporeal membrane oxygenation (ECMO) has been utilized in congenital diaphragmatic hernia (CDH) patients with severe respiratory failure unresponsive to conventional medical treatment. We retrospectively reviewed 12 CDH patients who were treated using ECMO in our center between April 2008 and February 2011. The pre ECMO and on ECMO variables analyzed included gestational age, sex, birth weight, age at the time of ECMO cannulation, arterial blood gas analysis results, CDH location, timing of CDH repair operation, complications and survival. There were 9 boys and 3 girls. All patients were prenatally diagnosed. Mean gestational age was 38.8 +/- 1.7 weeks and mean birth weight was 3031 +/- 499 gram. Mean age at the time of ECMO cannulation was 29.9 +/- 28.9 hours. There were 4 patients who survived. Survivors showed higher 5 min Apgar scores (8.25 +/- 0.96 vs. 7.00 +/- 1.20, p=0.109), higher pre ECMO mean pH (7.258 +/- 0.830 vs. 7.159 +/- 0.986, p=0.073) and lower pre ECMO PaCO2 (48.2 +/- 7.9 vs. 64.8 +/- 16.1, p=0.109) without statistical significance. The hernia was located on the left side in 10 patients and the right side in 2 patients. The time interval from ECMO placement to operative repair was about 3~4 days in 5 early cases and around 24 in the remaining cases. There were 3 cases of post operative bleeding requiring re operation and 2 cases of abdominal compartment syndrome requiring abdominal fascia reopening. ECMO catheter reposition was required in 4 cases. Three cases of arterial or venous thrombosis were detected and improved with follow up. Our data suggests that ECMO therapy could save the lives of some neonates with CDH who can not be maintained on other treatment modalities. Protocolized management and accumulation of case experience might be valuable in improving outcomes for neonates with CDH treated with ECMO.