IMPROVEMENT IN SURVIVAL OF PATIENTS WITH CONGENITAL DIAPHRAGMATIC-HERNIA UTILIZING A STRATEGY OF DELAYED REPAIR AFTER MEDICAL AND OR EXTRACORPOREAL MEMBRANE-OXYGENATION STABILIZATION

Patients with congenital diaphragmatic hernia (CDH) symptomatic at birth treated at this institution over the past 6 years were reviewed. The patients were divided into two chronological groups for analysis: group 1, consisting of 15 patients treated from January 1984 through October 1987, a period during which acute CDH was considered to be a surgical emergency; and group 2, comprising 20 patients treated from November 1987 through October 1989 using a management protocol of delayed repair following medical and/or extracorporeal membrane oxygenation (ECMO) stabilization. These two groups did not differ significantly in gestational age, birth weight, Apgar scores, hernia side, or age at admission. Group 2 had a longer mean interval from admission to repair (26.5 v 1.8 h, P = .01) and average age at repair (31.0 v 6.5 h, P = .02) than did group 1. Prosthetic closure of the diaphragmatic defect was required more frequently in group 2 then in group 1 (63% v 31%, P = .07). Survival in group 2 was significantly greater than in group 1 (55% v 20%, P = .04). Seven group 2 patients (35%) achieved a prerepair or pre-ECMO PO2 > 100 mm Hg and all survived; four of the 13 "nonresponders" also survived. ECMO was used in 11 group 2 patients with five survivors (45%); four of these patients underwent repair prior to ECMO and seven underwent repair while on ECMO. It is concluded that the adoption of a strategy of delayed repair of acute CDH following medical and/or ECMO stabilization has improved survival at this institution, but almost half of the patients still have fatal pulmonary hypoplasia and/or persistent pulmonary hypertension. © 1991.