Outcome analysis of neonates with congenital diaphragmatic hernia treated with venovenous vs venoarterial extracorporeal membrane oxygenation

Yigit S. Guner, Robinder G. Khemani, Faisal G. Qureshi, Choo Phei Wee, Mary T. Austin, Fred Dorey, Peter T. Rycus, Henri Ford, Philippe Friedlich, James E. Stein

Research output: Contribution to journalArticle

58 Citations (Scopus)

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, Paco2 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.

Original languageEnglish (US)
Pages (from-to)1691-1701
Number of pages11
JournalJournal of Pediatric Surgery
Volume44
Issue number9
DOIs
StatePublished - Sep 1 2009
Externally publishedYes

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Extracorporeal Membrane Oxygenation
Newborn Infant
Mortality
Congenital Diaphragmatic Hernias
High-Frequency Ventilation
Apgar Score
Prenatal Diagnosis
Birth Weight
Nervous System
Gestational Age
Logistic Models
Regression Analysis
Organizations
Databases
Kidney

Keywords

  • ECMO
  • ELSO
  • Hernia
  • Mortality
  • Neonate
  • Risk
  • VA
  • VV

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Outcome analysis of neonates with congenital diaphragmatic hernia treated with venovenous vs venoarterial extracorporeal membrane oxygenation. / Guner, Yigit S.; Khemani, Robinder G.; Qureshi, Faisal G.; Wee, Choo Phei; Austin, Mary T.; Dorey, Fred; Rycus, Peter T.; Ford, Henri; Friedlich, Philippe; Stein, James E.

In: Journal of Pediatric Surgery, Vol. 44, No. 9, 01.09.2009, p. 1691-1701.

Research output: Contribution to journalArticle

Guner, Yigit S. ; Khemani, Robinder G. ; Qureshi, Faisal G. ; Wee, Choo Phei ; Austin, Mary T. ; Dorey, Fred ; Rycus, Peter T. ; Ford, Henri ; Friedlich, Philippe ; Stein, James E. / Outcome analysis of neonates with congenital diaphragmatic hernia treated with venovenous vs venoarterial extracorporeal membrane oxygenation. In: Journal of Pediatric Surgery. 2009 ; Vol. 44, No. 9. pp. 1691-1701.
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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, Paco2 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.",
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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

AU - Friedlich, Philippe

AU - Stein, James E.

PY - 2009/9/1

Y1 - 2009/9/1

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, Paco2 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.

AB - 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, Paco2 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.

KW - ECMO

KW - ELSO

KW - Hernia

KW - Mortality

KW - Neonate

KW - Risk

KW - VA

KW - VV

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