Timing of repair of congenital diaphragmatic hernia requiring extracorporeal membrane oxygenation support

Autor: Neil N. Finer, Jean-Martin Laberge, Robert A. Hallgren, Anne J. Tierney, Vincent R. Adolph, Therese Perreault, David L. Sigalet
Rok vydání: 1995
Předmět:
Heart Defects
Congenital
Alveolar capillary dysplasia
medicine.medical_specialty
Time Factors
Hypertension
Pulmonary
medicine.medical_treatment
Pulmonary insufficiency
Gestational Age
Nitric Oxide
High-Frequency Jet Ventilation
Extracorporeal Membrane Oxygenation
Postoperative Complications
Cause of Death
medicine
Extracorporeal membrane oxygenation
Humans
Hernia
Philosophy
Medical
Hypoxia
Survival rate
Retrospective Studies
Cyanosis
Hernia
Diaphragmatic
Ventilators
Mechanical
business.industry
Infant
Newborn
Congenital diaphragmatic hernia
General Medicine
medicine.disease
Hernia repair
Pulmonary hypertension
Capillaries
Surgery
Oxygen
Pulmonary Alveoli
Survival Rate
surgical procedures
operative
Elective Surgical Procedures
Anesthesia
Pediatrics
Perinatology and Child Health
Hernias
Diaphragmatic
Congenital
Respiratory Insufficiency
business
Zdroj: Journal of Pediatric Surgery. 30:1183-1187
ISSN: 0022-3468
DOI: 10.1016/0022-3468(95)90017-9
Popis: Treatment of congenital diaphragmatic hernia (CDH) has undergone a revolutionary change in philosophy, from previous urgent repair to the present practice of stabilization and delayed repair. However, when extracorporeal membrane oxygenation (ECMO) is required, many people believe that the risk of postoperative pulmonary hypertension (PPHN) mandates hernia repair while on ECMO. This report details the experience in two ECMO centers with stabilization, ECMO if required, and CDH repair post-ECMO. All CDH patients symptomatic in the first hour of life with a gestational age of at least 34 weeks during the period were reviewed retrospectively. Standard criteria were used to select patients for ECMO. High-frequency jet or oscillating ventilators and nitric oxide were not routinely available throughout the study period, but were used in some of the more recent patients. A total of 60 patients presented to the two centers; 24 cases were stabilized with conventional management, repair of the CDH was done elective, and survival was 100%. Eight patients were referred after having repair elsewhere; six survived (75%). The two deaths were attributable to associated lethal lesions--complex cyanotic heart disease and alveolar capillary dysplasia. Eight patients who required ECMO were managed with the intention of repairing the defect on ECMO. Four survived (50%). Two patients died before repair. Twenty patients were managed with ECMO, with the intention of repairing the defect after decannulation. Overall survival was 13 (65%), deaths were caused by pre-ECMO hypoxia, pulmonary insufficiency, and associated cardiac disease. No patient had recurrent pulmonary hypertension after late repair.(ABSTRACT TRUNCATED AT 250 WORDS)
Databáze: OpenAIRE
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