Extracorporeal Membrane Oxygenation Following Repair of Congenital Diaphragmatic Hernias

Max Langham, Thomas M. Krummel, Lazar J. Greenfield, David E.M. Drucker, Thomas F. Tracy, Dawn G. Mueller, Anthony Napolitano, Barry V. Kirkpatrick, Arnold M. Salzberg

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

From 1981 through 1986, 8 newborns with congenital diaphragmatic hernia required herniorrhaphy in the first 8 hours of life. Extracorporeal membrane oxygenation (ECMO) was employed in 7 after they met local criteria predictive of 95% mortality. These criteria were an alveolar-postductal arterial oxygen gradient greater than 600 mm Hg for 12 hours or hemodynamic instability. Four of these 7 patients had unremitting hypoxemia after herniorrhaphy (no “honeymoon” period), 3 of whom survived. One additional patient died, producing a mortality of 29%. ECMO used for 68 to 241 hours (mean, 163 hours) provided reliable oxygenation in all. Deaths resulted from disseminated intravascular coagulation and bleeding, and bleeding and pulmonary failure after ligation of a patent ductus arteriosus. Complications occurred in 6 patients and included bleeding (3), hernia recurrence (3), and air embolism (1). Follow-up ranging from 1 year to 6 years after discharge of the 5 survivors shows normal growth and development in 4. The reported mortality without ECMO following congenital diaphragmatic herniorrhaphy in the first 8 hours of life ranges between 60 and 80%. While bleeding may present problems, survival of newborns with refractory hypoxemia after diaphragmatic repair has improved with ECMO.

Original languageEnglish (US)
Pages (from-to)247-252
Number of pages6
JournalAnnals of Thoracic Surgery
Volume44
Issue number3
DOIs
StatePublished - Jan 1 1987
Externally publishedYes

Fingerprint

Extracorporeal Membrane Oxygenation
Herniorrhaphy
Hemorrhage
Mortality
Newborn Infant
Air Embolism
Patent Ductus Arteriosus
Disseminated Intravascular Coagulation
Hernia
Growth and Development
Ligation
Survivors
Hemodynamics
Oxygen
Recurrence
Lung
Survival
Congenital Diaphragmatic Hernias
Hypoxia

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Langham, M., Krummel, T. M., Greenfield, L. J., Drucker, D. E. M., Tracy, T. F., Mueller, D. G., ... Salzberg, A. M. (1987). Extracorporeal Membrane Oxygenation Following Repair of Congenital Diaphragmatic Hernias. Annals of Thoracic Surgery, 44(3), 247-252. https://doi.org/10.1016/S0003-4975(10)62064-4

Extracorporeal Membrane Oxygenation Following Repair of Congenital Diaphragmatic Hernias. / Langham, Max; Krummel, Thomas M.; Greenfield, Lazar J.; Drucker, David E.M.; Tracy, Thomas F.; Mueller, Dawn G.; Napolitano, Anthony; Kirkpatrick, Barry V.; Salzberg, Arnold M.

In: Annals of Thoracic Surgery, Vol. 44, No. 3, 01.01.1987, p. 247-252.

Research output: Contribution to journalArticle

Langham, M, Krummel, TM, Greenfield, LJ, Drucker, DEM, Tracy, TF, Mueller, DG, Napolitano, A, Kirkpatrick, BV & Salzberg, AM 1987, 'Extracorporeal Membrane Oxygenation Following Repair of Congenital Diaphragmatic Hernias', Annals of Thoracic Surgery, vol. 44, no. 3, pp. 247-252. https://doi.org/10.1016/S0003-4975(10)62064-4
Langham, Max ; Krummel, Thomas M. ; Greenfield, Lazar J. ; Drucker, David E.M. ; Tracy, Thomas F. ; Mueller, Dawn G. ; Napolitano, Anthony ; Kirkpatrick, Barry V. ; Salzberg, Arnold M. / Extracorporeal Membrane Oxygenation Following Repair of Congenital Diaphragmatic Hernias. In: Annals of Thoracic Surgery. 1987 ; Vol. 44, No. 3. pp. 247-252.
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