Does the ex utero intrapartum treatment to extracorporeal membrane oxygenation procedure change morbidity outcomes for high-risk congenital diaphragmatic hernia survivors?

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• 作者：Hester F. Shieh^a ; Jay M. Wilson^a ; ^b ; Catherine A. Sheils^c ; C. Jason Smithers^a ; ^b ; Virginia S. Kharasch^c ; Ronald E. Becker^c ; Mollie Studley^c ; Donna Morash^a ; ^b ; Terry L. Buchmiller^a ; ^b ; ^{terry.buchmiller@childrens.harvard.edu}
• 关键词：Congenital diaphragmatic hernia ; Ex utero intrapartum treatment ; Extracorporeal membrane oxygenation ; CDH morbidity
• 刊名：Journal of Pediatric Surgery
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：52
• 期：1
• 页码：22-25
• 全文大小：199 K
• 卷排序：52

文摘

In high-risk congenital diaphragmatic hernia (CDH), significant barotrauma or death can occur before extracorporeal membrane oxygenation (ECMO) can be initiated. We previously examined ex utero intrapartum treatment (EXIT)-to-ECMO in our most severe CDH patients, but demonstrated no survival advantage. We now report morbidity outcomes in survivors of this high-risk cohort to determine whether EXIT-to-ECMO conferred any benefit.MethodsAll CDH survivors with < 15% predicted lung volume (PPLV) from September 1999 to December 2010 were included. We recorded prenatal imaging, defect size, and pulmonary, nutritional, cardiac, and neurodevelopmental outcomes.ResultsSeventeen survivors (8 EXIT-to-ECMO, 9 non-EXIT) had an average PPLV of 11.7%. Eight of 9 non-EXIT received ECMO within 2 days. There were no significant defect size differences between groups, mostly left-sided (13/17) and type D (12/17). Average follow-up was 6.7 years (0–13 years). There were no statistically significant differences in outcomes, including supplemental oxygen, diuretics, gastrostomy, weight-for-age Z scores, fundoplication, pulmonary hypertension, stroke or intracranial hemorrhage rate, CDH recurrence, and reoperation. No survivor in our cohort was neurologically devastated. All had mild motor and/or speech delay, which improved in most.ConclusionsIn this pilot series of severe CDH survivors, EXIT-to-ECMO confers neither significant survival nor long-term morbidity benefit.Level of evidenceLevel III treatment study.