Mortality with extracorporeal membrane oxygenation following repair of congenital diaphragmatic hernia in 93 infants

The results of extracorporeal membrane oxygenation (ECMO) following repair of congenital diaphragmatic hernia (CDH) are analyzed for 93 neonates reported to the Neonatal ECMO Registry. Each infant was symptomatic at birth and developed life-threatening hypoxemia after herniorrhaphy. ECMO was used after neonates met criteria predictive of death in individual centers. These included (1) failure of medical therapy to reverse hypoxemia (35 neonates); (2) acute clinical deterioration making death appear likely (37 neonates); (3) AaDO₂>600 for 8 hours (13 neonates); (4) oxygen index score of 51 for 4.8 hours (5 neonates); and (5) cardiac arrest (1 neonate). With ECMO, 52 infants (58%) survived and were discharged. Pre-ECMO arterial blood gas analysis was not predictive of outcome. Mortality was higher in small premature infants. ECMO corrected the hypoxemia, which usually causes death following congenital diaphragmatic herniorrhaphy. Unfortunately, 47 major bleeding complications occurred with 29 deaths. Therefore, improved survival may depend on new methods designed to prevent bleeding.