Left ventricular cardiac output is a reliable predictor of extracorporeal life support in neonates with congenital diaphragmatic hernia

Introduction: The use of extracorporeal membrane oxygenation (ECMO) is considered by many authors as one of the most important technological advances in the care of newborns with congenital diaphragmatic hernia. The main objective of this study was to report the experience of a Portuguese ECMO center in the treatment of congenital diaphragmatic hernia.Material and Methods: Descriptive retrospective study of newborns with congenital diaphragmatic hernia requiring ECMO support in a Pediatric Intensive Care Unit from January 2012 to December 2019. Data collection using the Extracorporeal Life Support Organization registration and unit data base.Results: Fourteen newborns were included, all with left congenital diaphragmatic hernia, in a total of 15 venoarterial ECMO cycles. The median gestational age was 38 weeks and the median birth weight was 2.950 kg. Surgical repair was performed before entry into ECMO in six, during in seven and after in one newborn. The average age at placement was 3.3 days and the median cycle duration was 16 days. Prior to ECMO, all newborns had severe hypoxemia and acidosis despite optimized ventilatory support, with nitric oxide and inotropic therapy. After 24 hours on ECMO, there was correction of acidosis, improvement of oxygenation and hemodynamic stability. All cycles presented mechanical complications, the most frequent being the presence of clots in the circuit. The most frequent physiological complications were hemorrhagic and embolic (three newborns suffered an ischemic stroke during the cycle). Five newborns (35.7%) died, all associated with complications (two strokes, two massive bleedings and one accidental decannulation). Chronic lung disease, poor weight gain and psychomotor developmental delay were the most frequent long-term morbidities.Discussion: Despite technological advances in respiratory care and improved safety of the ECMO technique, the management of these newborns is complex and there are still several open questions, including the appropriate selection of patients, the best approach and time for surgical correction, and the treatment of pulmonary hypertension in the presence of persistent fetal shunts.Conclusion: Survival rate was higher than reported in 2017 Extracorporeal Life Support Organization report (64% versus 50%). Mechanical and hemorrhagic complications were very frequent.

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Extracorporeal life support with an integrated left ventricular vent in children with a low cardiac output

Cardiology in the Young ◽

10.1017/s1047951113001017 ◽

2013 ◽

Vol 24 (4) ◽

pp. 654-660 ◽

Cited By ~ 4

Author(s):

Stany Sandrio ◽

Wolfgang Springer ◽

Matthias Karck ◽

Matthias Gorenflo ◽

Alexander Weymann ◽

...

Keyword(s):

Cardiac Output ◽

Cardiac Failure ◽

Life Support ◽

Extracorporeal Life Support ◽

Left Ventricular ◽

Neurological Dysfunction ◽

Left Heart ◽

Low Cardiac Output ◽

Cardiac Thrombus ◽

The Right

AbstractBackground: The aim of this study was to evaluate our experience in central extracorporeal life support with an integrated left ventricular vent in children with cardiac failure. Methods: Eight children acquired extracorporeal life support with a left ventricular vent, either after cardiac surgery (n = 4) or during an acute cardiac illness (n = 4). The ascending aorta and right atrium were cannulated. The left ventricular vent was inserted through the right superior pulmonary vein and connected to the venous line on the extracorporeal life support such that active left heart decompression was achieved. Results: No patient died while on support, seven patients were successfully weaned from it and one patient was transitioned to a biventricular assist device. The median length of support was 6 days (range 5–10 days). One patient died while in the hospital, despite successful weaning from extracorporeal life support. No intra-cardiac thrombus or embolic stroke was observed. No patient developed relevant intracranial bleeding resulting in neurological dysfunction during and after extracorporeal life support. Conclusions: In case of a low cardiac output and an insufficient inter-atrial shunt, additional left ventricular decompression via a vent could help avoid left heart distension and might promote myocardial recovery. In pulmonary dysfunction, separate blood gas analyses from the venous cannula and the left ventricular vent help detect possible coronary hypoxia when the left ventricle begins to recover. We recommend the use of central extracorporeal life support with an integrated left ventricular vent in children with intractable cardiac failure.

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Effect of very delayed repair of congenital diaphragmatic hernia on survival and extracorporeal life support use

Surgery ◽

10.1016/s0039-6060(96)80029-8 ◽

1996 ◽

Vol 120 (4) ◽

pp. 766-773 ◽

Cited By ~ 24

Author(s):

Craig A. Reicker ◽

Ronald B. Hirschl ◽

Robert Schumacher ◽

James D. Geiger ◽

Charles Cox ◽

...

Keyword(s):

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Life Support ◽

Extracorporeal Life Support ◽

Delayed Repair

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Survival Benefit Associated With the Use of Extracorporeal Life Support for Neonates With Congenital Diaphragmatic Hernia

Annals of Surgery ◽

10.1097/sla.0000000000003928 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Tim Jancelewicz ◽

Max R. Langham ◽

Mary E. Brindle ◽

Zachary E. Stiles ◽

Pamela A. Lally ◽

...

Keyword(s):

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Survival Benefit ◽

Life Support ◽

Extracorporeal Life Support

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Extracorporeal Life Support in Patients with Congenital Diaphragmatic Hernia: How Long Should We Treat?

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2013.12.047 ◽

2014 ◽

Vol 218 (4) ◽

pp. 808-817 ◽

Cited By ~ 33

Author(s):

David W. Kays ◽

Saleem Islam ◽

Douglas S. Richards ◽

Shawn D. Larson ◽

Joy M. Perkins ◽

...

Keyword(s):

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Life Support ◽

Extracorporeal Life Support

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Early, Postnatal Pulmonary Hypertension Severity Predicts Inpatient Outcomes in Congenital Diaphragmatic Hernia

Neonatology ◽

10.1159/000512966 ◽

2021 ◽

pp. 1-8

Author(s):

Dalya Munves Ferguson ◽

Vikas S. Gupta ◽

Pamela A. Lally ◽

Matias Luco ◽

KuoJen Tsao ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Life Support ◽

Extracorporeal Life Support ◽

Systolic Pressure ◽

Right Ventricular Systolic Pressure ◽

Ventricular Systolic Pressure ◽

Inpatient Outcomes ◽

Increased Risk

Introduction: Pulmonary hypertension (PH) is the major pathophysiologic consequence of congenital diaphragmatic hernia (CDH). We aimed to evaluate the association between early CDH-associated PH (CDH-PH) and inpatient outcomes. Methods: The CDH Study Group registry was queried for infants born 2015–2019 with echocardiograms before 48h of life. PH was categorized using echocardiographic findings: none, mild (right ventricular systolic pressure <2/3 systemic), moderate (between 2/3 systemic and systemic), or severe (supra-systemic). Univariate and multivariate analyses were performed. Adjusted Poisson regression was used to assess the primary composite outcome of mortality or oxygen support at 30 days. Results: Of 1,472 patients, 86.5% had CDH-PH: 13.9% mild (n = 193), 44.4% moderate (n = 631), and 33.2% severe (n = 468). On adjusted analysis, the primary outcome of mortality or oxygen support at 30 days occurred more frequently in infants with moderate (incidence rate ratio [IRR] 1.8, 95% confidence interval [CI], 1.2–2.6) and severe CDH-PH (IRR 2.0, 95% CI, 1.3–2.9). Extracorporeal life support (ECLS) utilization was associated only with severe CDH-PH after adjustment (IRR 1.8, 95% CI, 1.0–3.3). Discussion/Conclusion: Early, postnatal CDH-PH is independently associated with increased risk for mortality or oxygen support at 30 days and utilization of ECLS. Early echocardiogram is a valuable prognostic tool for early, inpatient outcomes in neonates with CDH.

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