Extracorporeal Membrane Oxygenation (ECMO) and its complications in newborns with congenital diaphragmatic hernia

医学 体外膜肺氧合 先天性膈疝 回顾性队列研究 队列 体外 外科 呼吸衰竭 膈式呼吸 儿科 内科学 胎儿 怀孕 生物 遗传学 替代医学 病理
作者
Latoya A. Stewart,Rafael Klein-Cloud,Claire Gerall,Weijia Fan,Jessica Price,Rebecca Hernan,Usha Krishnan,Eva W. Cheung,William Middlesworth,Diana Vargas,Russell S. Miller,Lynn L. Simpson,Wendy K. Chung,Vincent Duron
出处
期刊:Journal of Pediatric Surgery [Elsevier]
卷期号:57 (8): 1642-1648 被引量:4
标识
DOI:10.1016/j.jpedsurg.2021.12.028
摘要

Extracorporeal Membrane Oxygenation (ECMO) is offered to patients with congenital diaphragmatic hernia (CDH) who are in severe respiratory and cardiac failure. We aim to describe the types of complications among these patients and their impact on survival.A single-center, retrospective review of CDH patients cannulated onto ECMO between January 2005 and November 2020 was conducted. ECMO complications, as categorized by the Extracorporeal Life Support Organization (ELSO), were correlated with survival status. Descriptive statistics were used to compare observed complications between survivors and non-survivors.In our cohort of CDH neonates, 21% (54/258) were supported with ECMO, of whom, 61% (33/54) survived. Survivors and non-survivors were similar in baseline characteristics except for birthweight z-score (p = 0.043). Seventy percent of CDH neonates experienced complications during their ECMO run, with the most common categories being metabolic (48.1%) and mechanical (38.9%), followed by hemorrhage (22.2%), neurological (18.5%), renal (11.1%), pulmonary (7.4%), and cardiovascular (7.4%). The median number of complications per patient was higher in the non-survivor group (2 (IQR: 1-4) vs 1 (IQR: 0-2), p = 0.043). In addition, mechanical (57.1% vs 27.3%, p = 0.045) and renal (28.6% vs 0%, p = 0.002) complications were more common among non-survivors compared to survivors.Complications occur frequently among ECMO-treated newborns with CDH, some of which have serious long-term consequences. Survivors had higher birth weight z-scores, shorter ECMO runs, and fewer complications per patient. Mechanical and renal complications were independently associated with mortality, emphasizing the utility of more focused strategies to target fluid balance and renal protection and to prevent circuit and cannula complications.
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