A correlation of pulmonary hypoplasia, mean airway pressure, and survival in congenital diaphragmatic hernia treated with extracorporeal membrane oxygenation.
Thirty infants with congenital diaphragmatic hernia (CDH) who required therapy within the first day of life were treated in our institution over the past 3 years. Eighteen of these infants were not treated with extracorporeal membrane oxygenation (ECMO). Survival in this group was 83%. Twelve infants were treated with ECMO. Seven (58%) were weaned from ECMO and ventilator support with six (50%) long-term survivors. Minimum preoperative alveolar-arterial oxygen gradient (AaDO2), maximum postoperative mean airway pressure (MAP), and pulmonary hypoplasia were evaluated. Bohn et al have prospectively shown that the relationship of PaCO2 to mechanical ventilatory requirements accurately predicted survival in a group of 58 infants with CDH in whom ECMO was not a therapeutic option. This criteria would predict nonsurvival in all 12 of our patients treated with ECMO, including the seven survivors. Differences between our ECMO and non-ECMO groups were statistically significant for all three criteria. All P values less than .05. Morphometric analysis of the lungs of all ECMO nonsurvivors revealed hypoplastic ipsilateral lungs by lung weight to body weight ratios and radial alveolar counts when compared with experimental and historical controls (P less than .05). The contralateral lung was hypoplastic in 80% of the nonsurvivors. There is a strong correlation between the maximum postoperative MAP and the degree of contralateral pulmonary hypoplasia (r = .03, P = .02). We conclude that the maximum postoperative MAP is an accurate predictor of survival in the treatment of CDH and can be correlated with the degree of pulmonary hypoplasia.(ABSTRACT TRUNCATED AT 250 WORDS)
Redmond
C
C
Division of Pediatric Surgery, Louisiana State University Medical Center, New Orleans.
Heaton
J
J
Calix
J
J
Graves
E
E
Farr
G
G
Falterman
K
K
Arensman
R
R
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D000013:Congenital Abnormalities / Q000150:complications / Q000628:therapy; D006548:Hernia, Diaphragmatic / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000009:adverse effects*; D007223:Infant; D008171:Lung Diseases / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology