Extracorporeal membrane oxygenation for congenital diaphragmatic hernia in Japan

Noboru Inamura, Noriaki Usui, Hiroomi Okuyama, Kouji Nagata, Yutaka Kanamori, Yuji Fujino, Shigehiro Takahashi, Masahiro Hayakawa, Tomoaki Taguchi

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Abstract

Background The aim of this study was to clarify how extracorporeal membrane oxygenation (ECMO) is used to treat congenital diaphragmatic hernia (CDH) in Japan. Methods We completed a nationwide survey of CDH involving 614 infants. The subjects included 43 patients who underwent ECMO. We compared the clinical data of the patients who did and did not survive ≥90 days, and analyzed the 24 h blood gas data in isolated CDH cases in both groups. Results Of the 43 CDH patients, non-isolated CDH associated with other life-threatening or chromosomal anomalies was diagnosed in six patients. Only one of these six patients was able to discontinue ECMO and survived, and the other five died shortly after birth. The other 37 patients all had isolated CDH. The reason for initiating ECMO in 31 of these patients was persistent pulmonary hypertension of the newborn (PPHN). In the 37 patients with isolated CDH, ECMO was initiated within 24 h after birth. Sixteen patients (37%) survived ≥90 days, and intact discharge was possible in eight cases. Among the isolated CDH patients, on ROC analysis of the lowest oxygenation index (OI) to predict 90 day survival, the cut-off was 15. Conclusions ECMO is used to treat PPHN starting from an early period after birth, but the mortality and morbidity are not favorable. For lowest OI, the index used to predict survival following ECMO, the cut-off was 15.

Original languageEnglish
Pages (from-to)682-686
Number of pages5
JournalPediatrics International
Volume57
Issue number4
DOIs
Publication statusPublished - Aug 1 2015

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Extracorporeal Membrane Oxygenation
Japan
Persistent Fetal Circulation Syndrome
Parturition
Congenital Diaphragmatic Hernias
Survival
ROC Curve
Gases
Morbidity

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health

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Extracorporeal membrane oxygenation for congenital diaphragmatic hernia in Japan. / Inamura, Noboru; Usui, Noriaki; Okuyama, Hiroomi; Nagata, Kouji; Kanamori, Yutaka; Fujino, Yuji; Takahashi, Shigehiro; Hayakawa, Masahiro; Taguchi, Tomoaki.

In: Pediatrics International, Vol. 57, No. 4, 01.08.2015, p. 682-686.

Research output: Contribution to journalArticle

Inamura, N, Usui, N, Okuyama, H, Nagata, K, Kanamori, Y, Fujino, Y, Takahashi, S, Hayakawa, M & Taguchi, T 2015, 'Extracorporeal membrane oxygenation for congenital diaphragmatic hernia in Japan', Pediatrics International, vol. 57, no. 4, pp. 682-686. https://doi.org/10.1111/ped.12554
Inamura N, Usui N, Okuyama H, Nagata K, Kanamori Y, Fujino Y et al. Extracorporeal membrane oxygenation for congenital diaphragmatic hernia in Japan. Pediatrics International. 2015 Aug 1;57(4):682-686. https://doi.org/10.1111/ped.12554
Inamura, Noboru ; Usui, Noriaki ; Okuyama, Hiroomi ; Nagata, Kouji ; Kanamori, Yutaka ; Fujino, Yuji ; Takahashi, Shigehiro ; Hayakawa, Masahiro ; Taguchi, Tomoaki. / Extracorporeal membrane oxygenation for congenital diaphragmatic hernia in Japan. In: Pediatrics International. 2015 ; Vol. 57, No. 4. pp. 682-686.
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abstract = "Background The aim of this study was to clarify how extracorporeal membrane oxygenation (ECMO) is used to treat congenital diaphragmatic hernia (CDH) in Japan. Methods We completed a nationwide survey of CDH involving 614 infants. The subjects included 43 patients who underwent ECMO. We compared the clinical data of the patients who did and did not survive ≥90 days, and analyzed the 24 h blood gas data in isolated CDH cases in both groups. Results Of the 43 CDH patients, non-isolated CDH associated with other life-threatening or chromosomal anomalies was diagnosed in six patients. Only one of these six patients was able to discontinue ECMO and survived, and the other five died shortly after birth. The other 37 patients all had isolated CDH. The reason for initiating ECMO in 31 of these patients was persistent pulmonary hypertension of the newborn (PPHN). In the 37 patients with isolated CDH, ECMO was initiated within 24 h after birth. Sixteen patients (37{\%}) survived ≥90 days, and intact discharge was possible in eight cases. Among the isolated CDH patients, on ROC analysis of the lowest oxygenation index (OI) to predict 90 day survival, the cut-off was 15. Conclusions ECMO is used to treat PPHN starting from an early period after birth, but the mortality and morbidity are not favorable. For lowest OI, the index used to predict survival following ECMO, the cut-off was 15.",
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