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Outcome analysis of neonates with congenital diaphragmatic hernia treated with venovenous vs venoarterial extracorporeal membrane oxygenation.
J Pediatr Surg. 2009 Sep; 44(9):1691-701.JP

Abstract

PURPOSE

Venoarterial extracorporeal membrane oxygenation (ECMO) (VA) is used more commonly in neonates with congenital diaphragmatic hernia (CDH) than venovenous ECMO (VV). We hypothesized that VV may result in comparable outcomes in infants with CDH requiring ECMO.

METHODS

We retrospectively analyzed the Extracorporeal Life Support Organization (ELSO) database (1991-2006). Multivariate logistic regression analyses were used to compare VV- and VA-associated mortality.

RESULTS

Four thousand one hundred fifteen neonates required ECMO, with an overall mortality rate of 49.6%. Venoarterial ECMO was used in 82% and VV in 18% of neonates. Pre-ECMO inotrope use and complications were equivalent between VA and VV. The mortality rate for VA and VV was 50% and 46%, respectively. After adjusting for birth weight, gestational age, prenatal diagnosis, ethnicity, Apgar scores, pH less than 7.20, Paco(2) greater than 50, requiring high-frequency ventilation, and year of ECMO, there was no difference in mortality between VV vs VA. Renal complications and on-ECMO inotrope use were more common with VV, whereas neurologic complications were more common with VA. The conversion rate from VV to VA was 18%; conversion was associated with a 56% mortality rate.

CONCLUSION

The short-term outcomes of VV and VA are comparable. Patients with CDH who fail VV may be predisposed to a worse outcome. Nevertheless, VV offers equal benefit to patients with CDH requiring ECMO while preserving the native carotid.

Authors+Show Affiliations

Department of Pediatric Surgery, Childrens Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19735810

Citation

Guner, Yigit S., et al. "Outcome Analysis of Neonates With Congenital Diaphragmatic Hernia Treated With Venovenous Vs Venoarterial Extracorporeal Membrane Oxygenation." Journal of Pediatric Surgery, vol. 44, no. 9, 2009, pp. 1691-701.
Guner YS, Khemani RG, Qureshi FG, et al. Outcome analysis of neonates with congenital diaphragmatic hernia treated with venovenous vs venoarterial extracorporeal membrane oxygenation. J Pediatr Surg. 2009;44(9):1691-701.
Guner, Y. S., Khemani, R. G., Qureshi, F. G., Wee, C. P., Austin, M. T., Dorey, F., Rycus, P. T., Ford, H. R., Friedlich, P., & Stein, J. E. (2009). Outcome analysis of neonates with congenital diaphragmatic hernia treated with venovenous vs venoarterial extracorporeal membrane oxygenation. Journal of Pediatric Surgery, 44(9), 1691-701. https://doi.org/10.1016/j.jpedsurg.2009.01.017
Guner YS, et al. Outcome Analysis of Neonates With Congenital Diaphragmatic Hernia Treated With Venovenous Vs Venoarterial Extracorporeal Membrane Oxygenation. J Pediatr Surg. 2009;44(9):1691-701. PubMed PMID: 19735810.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcome analysis of neonates with congenital diaphragmatic hernia treated with venovenous vs venoarterial extracorporeal membrane oxygenation. AU - Guner,Yigit S, AU - Khemani,Robinder G, AU - Qureshi,Faisal G, AU - Wee,Choo Phei, AU - Austin,Mary T, AU - Dorey,Fred, AU - Rycus,Peter T, AU - Ford,Henri R, AU - Friedlich,Philippe, AU - Stein,James E, PY - 2008/09/24/received PY - 2009/01/15/revised PY - 2009/01/15/accepted PY - 2009/9/9/entrez PY - 2009/9/9/pubmed PY - 2009/12/16/medline SP - 1691 EP - 701 JF - Journal of pediatric surgery JO - J Pediatr Surg VL - 44 IS - 9 N2 - PURPOSE: Venoarterial extracorporeal membrane oxygenation (ECMO) (VA) is used more commonly in neonates with congenital diaphragmatic hernia (CDH) than venovenous ECMO (VV). We hypothesized that VV may result in comparable outcomes in infants with CDH requiring ECMO. METHODS: We retrospectively analyzed the Extracorporeal Life Support Organization (ELSO) database (1991-2006). Multivariate logistic regression analyses were used to compare VV- and VA-associated mortality. RESULTS: Four thousand one hundred fifteen neonates required ECMO, with an overall mortality rate of 49.6%. Venoarterial ECMO was used in 82% and VV in 18% of neonates. Pre-ECMO inotrope use and complications were equivalent between VA and VV. The mortality rate for VA and VV was 50% and 46%, respectively. After adjusting for birth weight, gestational age, prenatal diagnosis, ethnicity, Apgar scores, pH less than 7.20, Paco(2) greater than 50, requiring high-frequency ventilation, and year of ECMO, there was no difference in mortality between VV vs VA. Renal complications and on-ECMO inotrope use were more common with VV, whereas neurologic complications were more common with VA. The conversion rate from VV to VA was 18%; conversion was associated with a 56% mortality rate. CONCLUSION: The short-term outcomes of VV and VA are comparable. Patients with CDH who fail VV may be predisposed to a worse outcome. Nevertheless, VV offers equal benefit to patients with CDH requiring ECMO while preserving the native carotid. SN - 1531-5037 UR - https://www.unboundmedicine.com/medline/citation/19735810/Outcome_analysis_of_neonates_with_congenital_diaphragmatic_hernia_treated_with_venovenous_vs_venoarterial_extracorporeal_membrane_oxygenation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3468(09)00032-3 DB - PRIME DP - Unbound Medicine ER -