Clinical variables associated with ECMO use and mortality in infants with CDH: A single-center experience

Abstract

BackgroundInfants with congenital diaphragmatic hernia (CDH) experience high morbidity and mortality. Patients with severe disease frequently do poorly despite standardized care and extracorporeal membrane oxygenation (ECMO) support. The purpose of this study was to describe clinical variables associated with ECMO utilization and mortality in patients with CDH at a regional referral center for neonatal ECMO support. MethodsWe performed a single-center retrospective study of infants with CDH admitted from January 2007 to July 2021. Demographic and clinical variables were compared for patients managed with and without ECMO and survivors versus non-survivors for both the entire time period and only January 2012 to July 2021, after implementation of a standardized CDH management guideline. Logistic regression was used to identify clinical variables associated with ECMO utilization and mortality. Results133 patients were eligible of which 87% underwent surgical repair, 28% had liver herniation, 31% utilized ECMO, and 74% survived to discharge. These trends were still seen after the standardized management guideline was implemented. Regression analysis showed that liver herniation, hypercarbia on admission, and vasopressor and sildenafil use were associated with ECMO utilization, which in turn increased the odds of in-hospital mortality. ConclusionsIncreased cardiorespiratory support in infants with CDH is associated with ECMO utilization and mortality. A better understanding of variables associated with disease severity and clinical course may help counsel families, further standardize care, and improve outcomes for this population.