Outcome analysis of neonates with congenital diaphragmatic hernia treated with venovenous vs venoarterial extracorporeal membrane oxygenation

Yigit S. Guner, Robinder G. Khemani, Faisal G. Qureshi, Choo Phei Wee, Mary T. Austin, Fred Dorey, Peter T. Rycus, Henri R. Ford, Philippe Friedlich, James E. Stein

Research output: Contribution to journalArticle

62 Scopus citations

Abstract

Purpose: Venoarterial extracorporeal membrane oxygenation (ECMO) (VA) is used more commonly in neonates with congenital diaphragmatic hernia (CDH) than venovenous ECMO (VV). We hypothesized that VV may result in comparable outcomes in infants with CDH requiring ECMO. Methods: We retrospectively analyzed the Extracorporeal Life Support Organization (ELSO) database (1991-2006). Multivariate logistic regression analyses were used to compare VV- and VA-associated mortality. Results: Four thousand one hundred fifteen neonates required ECMO, with an overall mortality rate of 49.6%. Venoarterial ECMO was used in 82% and VV in 18% of neonates. Pre-ECMO inotrope use and complications were equivalent between VA and VV. The mortality rate for VA and VV was 50% and 46%, respectively. After adjusting for birth weight, gestational age, prenatal diagnosis, ethnicity, Apgar scores, pH less than 7.20, Paco2 greater than 50, requiring high-frequency ventilation, and year of ECMO, there was no difference in mortality between VV vs VA. Renal complications and on-ECMO inotrope use were more common with VV, whereas neurologic complications were more common with VA. The conversion rate from VV to VA was 18%; conversion was associated with a 56% mortality rate. Conclusion: The short-term outcomes of VV and VA are comparable. Patients with CDH who fail VV may be predisposed to a worse outcome. Nevertheless, VV offers equal benefit to patients with CDH requiring ECMO while preserving the native carotid.

Original languageEnglish (US)
Pages (from-to)1691-1701
Number of pages11
JournalJournal of Pediatric Surgery
Volume44
Issue number9
DOIs
StatePublished - Sep 1 2009

Keywords

  • ECMO
  • ELSO
  • Hernia
  • Mortality
  • Neonate
  • Risk
  • VA
  • VV

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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    Guner, Y. S., Khemani, R. G., Qureshi, F. G., Wee, C. P., Austin, M. T., Dorey, F., Rycus, P. T., Ford, H. R., Friedlich, P., & Stein, J. E. (2009). Outcome analysis of neonates with congenital diaphragmatic hernia treated with venovenous vs venoarterial extracorporeal membrane oxygenation. Journal of Pediatric Surgery, 44(9), 1691-1701. https://doi.org/10.1016/j.jpedsurg.2009.01.017