Congenital diaphragmatic hernia, extracorporeal membrane oxygenation, and death: a spectrum of etiologies

• Published in: Journal of pediatric surgery Vol. 26; no. 9; p. 1023
• Main Authors: Price, M R, Galantowicz, M E, Stolar, C J
• Format: Journal Article
• Language: English
• Published: United States 01-09-1991
• Subjects: Bicarbonates - blood; Brain Death; Carbon Dioxide - blood; Cause of Death; Extracorporeal Membrane Oxygenation; Hernia, Diaphragmatic - mortality; Hernia, Diaphragmatic - therapy; Hernias, Diaphragmatic, Congenital; Humans; Hypertension, Pulmonary - blood; Hypertension, Pulmonary - etiology; Hypertension, Pulmonary - physiopathology; Infant, Newborn; Lung - abnormalities; Oxygen - blood; Retrospective Studies
• ISSN: 0022-3468
• DOI: 10.1016/0022-3468(91)90666-H

Extracorporeal Life Support Organization (ELSO) registry data show increased mortality in congenital diaphragmatic hernia (CDH) infants compared with other extracorporeal membrane oxygenation (ECMO) indications. To test the hypothesis that death might be related to various clinical parameters, retrospective data collection was solicited on 175 ECMO-related CDH deaths from 41 American ECMO centers (ELSO Registry 1980 through 1989). Data capture forms were received on 100 of 175 infants representing 29 of 41 centers. After review of all available material, a predominant cause of death was assigned. Other diagnoses were given secondary status. We analyzed arterial blood gas values at 6, 3, and 1 hour pre-ECMO, as well as at the time of highest recorded PO2 (preductal and postductal) and lowest recorded PCO2, and correlated these findings with predominant cause of death. The relationship between individual variables and cause of death was assessed by t test. Multivariate analysis was performed by using a stepwise discriminate procedure. The most common predominant causes of death were brain death (29%), pulmonary hypertension (25%), and pulmonary hypoplasia (17%). Correlation of arterial blood gas values at 6, 3, and 1 hour pre-ECMO with predominant causes of death established the following statistically significant associations (P less than .05): (1) pulmonary hypoplasia and low PO2 at 6 hours pre-ECMO; (2) brain death and low pH at 1 hour pre-ECMO; and (3) pulmonary hypertension and high HCO3- at 1 hour pre-ECMO.