Extracorporeal membrane oxygenation (ECMO): applications and results in patients with congenital diaphragmatic hernia

Abstract

Congenital diaphragmatic hernia (CDH) that causes symptoms within the first 24 h after birth often leads to fatal hypoxia due to refractory persistent pulmonary hypertension of the newborn (PPHN) and/or hypoplastic lungs despite aggressive ventilator care and pharmacological treatment. Since 1985, extracorporeal membrane oxygenation (ECMO) has been used in our hospital as “last resort” therapy for these patients. Of the 33 patients treated up to March 1992, 15(45.5%) were selected for ECMO. In 13 cases ECMO was used after repair of a CDH and in 2 patients with fatal cardiorespiratory disease it was started shortly after admission and the operation was carried out after stabilization on ECMO. Average birth weights were 2.96 kg and average gestational ages 39 weeks 1 day. The average age at the start of ECMO was 31.9 h, the average ECMO time was 99.1 h and the longest was 422 h. Eleven of the 15 patients who required ECMO survived, and the overall survival in the 33 CDH patients who presented with symptoms in the first 24 h was 78.8%, which was a significant improvement compared with the 57% survival in the 21 previous patients.