J Pediatr Surg. 2020 Feb 25. pii: S0022-3468(20)30171-8. doi: 10.1016/j.jpedsurg.2020.02.043. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/32169344
Predictors of long ECMO runs for congenital diaphragmatic hernia.
Delaplain PT1, Yu PT2, Ehwerhemuepha L3, Nguyen DV4, Jancelewicz T5, Stein J6, Harting MT7, Guner YS8.
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Abstract
BACKGROUND:
Although longer ECMO run times for patients with congenital diaphragmatic hernia (CDH) have been associated with worse outcomes, a large study has not been conducted to examine the risk factors for long ECMO runs.
METHODS:
The Extracorporeal Life Support Organization (ELSO) Registry from 2000 to 2015 was used to identify predictors of long ECMO runs in CDH patients. A long run was any duration of ≥14 days. Multivariable logistic regression models were used to examine the association between demographics, pre-ECMO blood gas/ventilator settings, comorbid conditions, and therapies on long ECMO runs.
RESULTS:
There were 4730 CDH-infants examined. The largest association with long ECMO runs was on-ECMO repair (OR: 3.72, 95% CI: 3.013-4.602, p < 0.001) and the use of THAM (OR: 1.463, 95% CI: 1.062-2.016, p = 0.02). Each drop in pH quartile was associated with an increased risk of long ECMO run: pH ≥ 7.3 (reference), pH 7.2-7.9 (OR 1.24, 95% CI: 0.98-1.57, p = 0.07), pH 7.08-7.19 (OR 1.46, 95% CI: 1.17-1.84, p = 0.001), pH ≤ 7.07 (OR 1.64, 95% CI: 1.29-2.07, p < 0.001).
CONCLUSIONS:
We found a correlation between both pre-ECMO demographics/timing of repair and the subsequent risk of long ECMO runs, providing insight for both providers and parents about the risk factors for longer runs.
TYPE OF STUDY:
Treatment Study.
LEVEL OF EVIDENCE:
Level III.
Copyright © 2020 Elsevier Inc. All rights reserved.
KEYWORDS:
Congenital diaphragmatic hernia (CDH); Extracorporeal membrane oxygenation (ECMO); NeonatePMID: 32169344 DOI: 10.1016/j.jpedsurg.2020.02.043
