Right-sided congenital diaphragmatic hernia: high utilization of extracorporeal membrane oxygenation and high survival.
OBJECTIVE
The purpose of the study was to assess the treatment strategies and outcome of right-sided congenital diaphragmatic hernia (R-CDH), particularly extracorporeal membrane oxygenation (ECMO).


METHODS
We reviewed the cases of 42 patients treated for R-CDH at our institution from 1991 to 2006. We gathered demographic information, documented ECMO use and the type of surgical repair, and compared outcomes with predicted survival as calculated by the CDH Study Group's equation.


RESULTS
Of the 35 patients included in our statistical analysis (7 were excluded), 12 (34%) were born at our institution, all of whom were prenatally diagnosed with R-CDH. Nineteen patients (54%) required ECMO therapy. Extracorporeal membrane oxygenation was initiated after repair of the R-CDH in 2 patients (11%). Of those patients who went on ECMO before repair, 4 patients (21%) were repaired on ECMO, 9 patients (47%) underwent repair after ECMO, and 4 patients (21%) underwent ECMO but died before their R-CDH could be repaired. Primary repair of the diaphragm was possible in 15 cases (56%), and primary closure of the abdominal incision was possible in 15 of the 23 open repairs (65%). The mean predicted survival for all 35 patients was 63%, whereas 28 (80%) actually survived. Logistic regression showed a significant association between the presence of cardiac defects and mortality (odds ratio = 0.008, P = .014).


CONCLUSIONS
Our data suggest that patients with R-CDH have high ECMO utilization and may experience greater relative benefit from ECMO as evidenced by their higher-than-expected overall survival. Extracorporeal membrane oxygenation may be found to have a distinctive role in managing R-CDH. More high-powered series are needed to elucidate differences between R-CDH and left-sided CDH that may dictate alternate forms of management.
Bryner
Benjamin S
BS
Department of Surgery, Section of Pediatric Surgery, The University of Michigan Medical School and The CS Mott Children's Hospital, Ann Arbor, MI 48109, USA.
Kim
Anne C
AC
Khouri
Joseph S
JS
Drongowski
Robert A
RA
Bruch
Steven W
SW
Hirschl
Ronald B
RB
Mychaliska
George B
GB
D000015:Abnormalities, Multiple / Q000453:epidemiology; D001034:Apgar Score; D001724:Birth Weight; D015199:Extracorporeal Membrane Oxygenation / Q000706:statistics & numerical data*; D005260:Female; D006330:Heart Defects, Congenital / Q000453:epidemiology; D006548:Hernia, Diaphragmatic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011296:Prenatal Diagnosis; D011379:Prognosis; D012189:Retrospective Studies; D012306:Risk; D015996:Survival Rate; D016896:Treatment Outcome