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ASAIO J. 2019 Jul;65(5):509-515. doi: 10.1097/MAT.0000000000000834.

Trends in Mortality and Risk Characteristics of Congenital Diaphragmatic Hernia Treated With Extracorporeal Membrane Oxygenation.

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From the Division of Pediatric Surgery, Children's Hospital of Orange County, Orange, California.
Department of Surgery, University of California Irvine Medical Center, Orange, California.
Department of Pediatric Surgery, Children's Hospital of Los Angeles, University of Southern California Los Angeles, CA.
Institute for Clinical and Translational Science, University of California, Irvine, California.
Pediatric Intensive Care Unit, Ospedale Pediatrico Bambino Gesu, Rome, Italy.
Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington.
Division of Neonatalogy, Children's Hospital of Orange County, Orange, California.
Department of Pediatric Surgery, University of Texas McGovern Medical School, Houston, Texas.
Department of Pediatric Surgery, Children's Memorial Hermann Hospital, Houston, Texas.
Department of Medicine, University of California Irvine, Orange, California.


Although the mortality of infants with congenital diaphragmatic hernia (CDH) has been improving since the late 1990s, this observation has not been paralleled among the CDH cohort receiving extracorporeal membrane oxygenation (ECMO). We sought to elucidate why the mortality rate in the CDH-ECMO population has remained at approximately 50% despite consistent progress in the field by examining the baseline risk profile/characteristics of neonates with CDH before ECMO (pre-ECMO). Neonates with a diagnosis of CDH were identified in the Extracorporeal Life Support Organization (ELSO) Registry from 1992 to 2015. Individual pre-ECMO risk score (RS) for mortality was categorized to pre-ECMO risk-stratified cohorts. Temporal trends based on individual-level mortality by risk cohorts were assessed by logistic regression. We identified 6,696 neonates with CDH. The mortality rates during this time period were approximately 50%. The average baseline pre-ECMO RS increased during this period: mean increase of 0.35 (95% confidence interval [CI]: 0.324-0.380). In the low-risk cohort, the likelihood of mortality increased over time: each 5 year change was associated with a 7.3% increased likelihood of mortality (odds ratio [OR]: 1.0726; 95% CI: 1.0060-1.1437). For the moderate-risk cohort, the likelihood of mortality decreased by 7.05% (OR: 0.9295; 95% CI: 0.8822-0.9793). There was no change in the odds of mortality for the high-risk cohort (OR: 0.9650; 95% CI: 0.8915-1.0446). Although the overall mortality rate remained approximately constant over time, the individual likelihood of death has declined over time in the moderate-risk cohort, increased in the low-risk cohort, and remained unchanged in the high-risk cohort.

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