title: Extracorporeal membrane oxygenation for congenital diaphragmatic hernia in Japan.
abstract: BACKGROUND
  The aim of this study was to clarify how extracorporeal membrane oxygenation (ECMO) is used to treat congenital diaphragmatic hernia (CDH) in Japan.
  
  
  METHODS
  We completed a nationwide survey of CDH involving 614 infants. The subjects included 43 patients who underwent ECMO. We compared the clinical data of the patients who did and did not survive ≥ 90 days, and analyzed the 24 h blood gas data in isolated CDH cases in both groups.
  
  
  RESULTS
  Of the 43 CDH patients, non-isolated CDH associated with other life-threatening or chromosomal anomalies was diagnosed in six patients. Only one of these six patients was able to discontinue ECMO and survived, and the other five died shortly after birth. The other 37 patients all had isolated CDH. The reason for initiating ECMO in 31 of these patients was persistent pulmonary hypertension of the newborn (PPHN). In the 37 patients with isolated CDH, ECMO was initiated within 24 h after birth. Sixteen patients (37%) survived ≥ 90 days, and intact discharge was possible in eight cases. Among the isolated CDH patients, on ROC analysis of the lowest oxygenation index (OI) to predict 90 day survival, the cut-off was 15.
  
  
  CONCLUSIONS
  ECMO is used to treat PPHN starting from an early period after birth, but the mortality and morbidity are not favorable. For lowest OI, the index used to predict survival following ECMO, the cut-off was 15.
authors.affiliation: Department of Pediatric Cardiology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Inamura
authors.affiliation: Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Usui
authors.affiliation: Department of Pediatric Surgery, Hyogo College of Medicine, Nishinomiya, Japan.
authors.forename: Hiroomi
authors.initials: H
authors.lastname: Okuyama
authors.affiliation: Department of Pediatric Surgery, Reproductive and Developmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Kouji
authors.initials: K
authors.lastname: Nagata
authors.affiliation: Department of General Surgery, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kanamori
authors.affiliation: Department of Intensive Care Unit, Osaka University Hospital, Osaka, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Fujino
authors.affiliation: Division of Neonatology, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Shigehiro
authors.initials: S
authors.lastname: Takahashi
authors.affiliation: Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Hayakawa
authors.affiliation: Department of Pediatric Surgery, Reproductive and Developmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Taguchi
mesh_terms: D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D065630:Hernias, Diaphragmatic, Congenital / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D015994:Incidence; D007223:Infant; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D007564:Japan / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends
keywords: congenital diaphragmatic hernia; extracorporeal membrane oxygenation; mortality; oxygenation index