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Shifting Risks and Conflicting Outcomes-ECMO for Neonates with Congenital Diaphragmatic Hernia in the Modern Era.
Turek, Joseph W; Nellis, Joseph R; Sherwood, Brenton G; Kotagal, Meera; Mesher, Andrew L; Thiagarajan, Ravi R; Patel, Sonali S; Avansino, Jeffrey R; Rycus, Peter T; McMullan, D Michael; Brogan, Thomas V.
Afiliação
  • Turek JW; Division of Pediatric Cardiac Surgery, University of Iowa Children's Hospital, Iowa City, IA. Electronic address: joseph.turek@duke.edu.
  • Nellis JR; University of Iowa Carver College of Medicine, Iowa City, IA.
  • Sherwood BG; University of Iowa Carver College of Medicine, Iowa City, IA.
  • Kotagal M; Department of Surgery, University of Washington, Seattle, WA.
  • Mesher AL; Department of Surgery, University of Washington, Seattle, WA.
  • Thiagarajan RR; Department of Cardiology, Boston Children's Hospital, Boston, MA.
  • Patel SS; Division of Pediatric Cardiology, Colorado Children's Hospital, Aurora, CO.
  • Avansino JR; Department of Surgery, University of Washington, Seattle, WA.
  • Rycus PT; Extracorporeal Life Support Organization, Ann Arbor, MI.
  • McMullan DM; Department of Surgery, University of Washington, Seattle, WA.
  • Brogan TV; Department of Pediatrics, University of Washington, Seattle, WA.
J Pediatr ; 190: 163-168.e4, 2017 11.
Article em En | MEDLINE | ID: mdl-29144241
OBJECTIVES: To update previously described trends for neonates with congenital diaphragmatic hernia (CDH) receiving ECMO with changes in recommendations for care, and to determine how recent advancements in respiratory care have affected this patient population. STUDY DESIGN: This study is a retrospective review of more than 2500 neonates with CDH who received ECMO listed in the Extracorporeal Life Support Organization (ELSO) registry. Cochran-Armitage and multivariate regression analyses were used to analyze changes in the patient population over time and in mortality-related risk factors. RESULTS: Almost one-half (48.1%) of the term neonates survived to discharge, representing a 13.8% decline in survival over the past 25 years (P < .0001). Over the past 10 years, the prevalence of respiratory acidosis more than doubled (P < .0001) and the prevalence of major complications increased (P < .001). During the same period, the number of ECMO courses longer than 1 week increased (P < .001), whereas the prevalence of multiple complications (>4) decreased (P < .0001). Surgeries performed on ECMO were associated with worse outcomes than those performed off ECMO. ECMO duration no longer represents a mortality-related risk factor. CONCLUSIONS: Survival rates for neonates with CDH receiving ECMO have continued to drop in the modern era. Although the safety of ECMO has improved over the last decade, the number of patients experiencing significant respiratory acidosis has more than doubled-increasing the risk of intracranial hemorrhage and overall mortality. The evidence for permissive hypercapnia remains mixed; nonetheless, we believe that the risks outweigh the rewards in this patient population.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Oxigenação por Membrana Extracorpórea / Hérnias Diafragmáticas Congênitas Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Female / Humans / Male / Newborn Idioma: En Revista: J Pediatr Ano de publicação: 2017 Tipo de documento: Article País de publicação: Estados Unidos
Texto completo
Adicionar na Minha BVS
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XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Oxigenação por Membrana Extracorpórea / Hérnias Diafragmáticas Congênitas Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Female / Humans / Male / Newborn Idioma: En Revista: J Pediatr Ano de publicação: 2017 Tipo de documento: Article País de publicação: Estados Unidos