Abstract
Infants with congenital diaphragmatic hernia (CDH) constitute the poorest prognoslic group of ECMO-treateiJ neonates (survival rate of 61% vs 83% overall). It has been suggested that BPDPO2 < 100, BPDPO2 < 60 and BPDPCO2 ≥ 40 may be used to exclude CDH patients unlikely to respond to therapy. We have previously reported that published predictors of high mortality in CDH patients, repaired prior to ECMO. were unreliable. We now report similar findings in a population of CDH infants treated with ECMO prior to surgical repair. Since 1989 we have placed CDH infants on ECMO prior to surgery if they are in extremis , with pO2 < 40 × 2 hours. The BPDPO2 was < 100 in all 16 patients treated, yet 9/16 (56%) survived.
Conclusions: 1)Neither BPDPO2 < 60, nor BPDPCO2 ≥40 distinguished survivors from non-survivors in CDH infants in extremis, treated with ECMO prior to surgery. 2)The heterogeneity of CDH patients and of the medical management between centers, warrants a multi-center assessment of this poor prognostic group.
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Sanchez, L., O'Brien, A., Anderson, K. et al. BEST POSTDUCTAL pO2 (BPDPO2) AND pCO2 (BPDPCO2) DO NOT PREDICT OUTCOME OF CDH INFANTS IN EXTREMIS, STABILIZED WITH ECMO PRIOR TO SURGICAL REPAIR. Pediatr Res 32, 614 (1992). https://doi.org/10.1203/00006450-199211000-00057
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DOI: https://doi.org/10.1203/00006450-199211000-00057