J Pediatr Surg. 2020 Feb 14. pii: S0022-3468(20)30065-8. doi: 10.1016/j.jpedsurg.2020.01.026. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/32067809
The development of multiorgan dysfunction in CDH-ECMO neonates is associated with the level of pre-ECMO support.
Delaplain PT1, Ehwerhemuepha L2, Nguyen DV3, Di Nardo M4, Jancelewicz T5, Awan S6, Yu PT6, Guner YS6; ELSO CDH Interest Group.
Congenital diaphragmatic hernia (CDH) is the most common indication for neonatal extracorporeal membrane oxygenation (ECMO), but mortality remains at 50%. Multiorgan failure can occur in 25% and has been linked to worse outcomes. We sought to examine the factors that would increase the risk of multiorgan dysfunction (MOD).
The Extracorporeal Life Support Organization (ELSO) database was used to identify infants with CDH (2000-2015). The primary outcome was MOD, which was defined as the presence of organ failure in ≥2 organ systems. We used a multivariable logistic regression to examine the effect of demographics, pre-ECMO respiratory status, comorbidities, and therapies on MOD.
There were a total of 4374 CDH infants who were treated with ECMO. Overall mortality was 52.4%. The risk models demonstrated that pre-ECMO cardiac arrest (OR 1.458, CI: 1.146-1.861, p = 0.002) and hand-bagging (OR 1.461, CI: 1.094-1.963, p = 0.032) had the strongest association with MOD. In addition, other pre-ECMO indicators of disease severity (pH, HFOV, MAP, 5-min APGAR) and pre-ECMO therapies (bicarb, neuromuscular [NM] blockers) were also associated with MOD.
The level of pre-ECMO support has a significant association with the development of MOD, and initiation of ECMO prior to arrest seems to be critical to avoid complications.
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Copyright © 2020 Elsevier Inc. All rights reserved.
Congenital diaphragmatic hernia; Extracorporeal life support (ECLS); Extracorporeal membrane oxygenation (ECMO); Multisystem organ failurePMID: 32067809 DOI: 10.1016/j.jpedsurg.2020.01.026