Late death after extracorporeal membrane oxygenation for congenital diaphragmatic hernia.
OBJECTIVE
The aim of this study was to determine the long-term outcome of neonates who required extracorporeal membrane oxygenation (ECMO) for respiratory insufficiency associated with congenital diaphragmatic hernia (CDH).


METHODS
All neonates born with CDH, who required ECMO (oxygenation index over 40 in the presence of maximal support) during a 6-year period, were reviewed. The median duration of follow-up for survivors was 14 months (range, 9 to 22 months).


RESULTS
Of 72 neonates with CDH, 11 (15%) required ECMO. The median age at the start of ECMO was 2 days (range, 1 to 4); duration was 9 days (range, 4 to 17); post-ECMO ventilation was 27 days (range, 8 to 86); and stay in intensive care unit, 33 days (range, 8 to 133). Three patients survived and are not oxygen dependent. There were three early deaths at 9 to 16 days and five late deaths at a median of 6 months (range, 2 to 32 months) secondary to chronic lung disease (n = 3) and infection (n = 2). Four of the five patients with late deaths were oxygen dependent at discharge from hospital. Three of the late death patients and one survivor underwent a fundoplication for gastrooesophageal reflux.


CONCLUSIONS
Neonates born with CDH and requiring ECMO had a significant late mortality. Follow-up for more than 1 year is indicated to assess the benefit of ECMO for this diagnosis. The authors report only three long-term survivors from 11 ECMO patients selected from a total of 72 neonates with CDH.
Schoeman
L
L
Department of Paediatric Surgery, Institute of Child Health and Great Ormond Street Hospital for Children, London, England.
Pierro
A
A
Macrae
D
D
Spitz
L
L
Kiely
E M
EM
Drake
D P
DP
D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D006548:Hernia, Diaphragmatic / Q000401:mortality* / Q000628:therapy*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D016019:Survival Analysis; D016896:Treatment Outcome