Document Detail


Predictors of survival in congenital diaphragmatic hernia patients requiring extracorporeal membrane oxygenation: CNMC 15-year experience.
MedLine Citation:
PMID:  20147960     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To review outcomes of patients with congenital diaphragmatic hernia (CDH) requiring extracorporeal membrane oxygenation (ECMO) at a level IIIC neonatal intensive care unit and to determine if pre-ECMO respiratory status can help predict mortality.
STUDY DESIGN: A single-center retrospective chart review was conducted on all infants with CDH treated with ECMO in the past 15 years. Demographic and clinical information, including pre-ECMO ventilatory and blood gas data, was collected. Differences between survivors and non-survivors were evaluated using independent samples t-/Mann-Whitney U-and Fisher's exact/chi (2)-tests for continuous and categorical data, respectively. Cox regression analysis was performed to evaluate predictors of survival while controlling for covariates. Significant predictors were further explored with receiver operating characteristic (ROC) curve and Kaplan-Meier survival analysis.
RESULT: Overall survival of the population of 62 patients treated with ECMO was 50%. Survivor and non-survivors were similar in birth weight, gestational age, gender, race and Apgar scores. Approximately 80% of patients in both groups had a left-sided defect. Less than half of patients were prenatally diagnosed in either group. Patients in the non-survivor group had associated anomalies (42 vs 23% for survivors) but this was not statistically significant (P=0.303). Non-survivors were more likely to be put on ECMO earlier, stay on ECMO longer and be operated upon later. On pre-ECMO blood gas analyses, survivors had higher pH and PaO(2), and lower oxygenation index and PaCO(2) compared with non-survivors. After controlling for covariates, a lower minimum PaCO(2) and side of defect were the only independent predictors of survival. ROC curve for minimum pre-ECMO PaCO(2) had a significant area under the curve (0.72, P=0.003). Survival was 27% in babies unable to achieve a pre-ECMO PaCO(2) <60 mm Hg whereas no patients survived if their lowest pre-ECMO PaCO(2) was >70 mm Hg.
CONCLUSION: Minimum achievable pre-ECMO PaCO(2) is an independent predictor of survival in patients with CDH requiring ECMO life support. These data provide useful prognostic information for counseling families and may facilitate direction of care in extreme cases where the degree of pulmonary hypoplasia may be incompatible with life.
Authors:
S B Hoffman; A N Massaro; C Gingalewski; B L Short
Publication Detail:
Type:  Journal Article     Date:  2010-02-11
Journal Detail:
Title:  Journal of perinatology : official journal of the California Perinatal Association     Volume:  30     ISSN:  1476-5543     ISO Abbreviation:  J Perinatol     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-29     Completed Date:  2010-11-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8501884     Medline TA:  J Perinatol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  546-52     Citation Subset:  IM    
Affiliation:
Department of Pediatrics, Children's National Medical Center, Washington, DC 20010, USA.
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MeSH Terms
Descriptor/Qualifier:
Anoxia / diagnosis,  etiology*
Blood Gas Analysis
Extracorporeal Membrane Oxygenation*
Hernia, Diaphragmatic / complications*,  congenital*,  therapy
Humans
Infant, Newborn
Kaplan-Meier Estimate
Male
Predictive Value of Tests
ROC Curve
Retrospective Studies

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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