Abstract
Rationale – Management of congenital diaphragmatic hernia (CDH) has changed considerably over the past decade with increased survival rates reported. Objective – We wished to audit the outcome of our medical management following a significant change in protocol. Methods – A retrospective study was performed between January 1996 and December 2006. The management and the outcome of 143 consecutive patients was reviewed at a tertiary paediatric intensive care unit in the UK. We recorded therapeutic measures offered, including high frequency oscillatory ventilation (HFOV) and inhaled nitric oxide (iNO), worst oxygenation index (OI), number of cases requiring ECMO and survival rate at one year of life. Two treatment periods of five and a half years each were compared. Measurements and Main Results – Between 1996 and 2006 our overall survival rate increased from 69% to 81%. There was an increase in the use of iNO from 31% to 45% and HFOV from 34% to 61%. There was a significant increase in extra corporeal membrane oxygenation (ECMO) survival rate from 33% to 67% between the two periods. There was no difference in survival rates for patients with OI between 40–60 if offered conventional treatment or ECMO. However, patients with an OI>60 showed a clear survival benefit with ECMO. Conclusion – Newer treatment modalities including HFOV, iNO and ECMO have improved survival rates in patients with CDH. ECMO is reserved for patients who are refractory to maximal medical therapy. It may be possible to defer commencing ECMO until an OI>60.
Published Version
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