Is ECMO Dispensable ? Outcome of Newborns with CDH-A Single Center Experience and Review of Literature

Objective: Congenital diaphragmatic hernia (CDH) may lead to cardio-respiratory distress in affected newborns and can be incompatible with life. Extracorporeal Membrane oxygenation (ECMO) is supposed to improve survival of infants who cannot be managed with conventional therapy. Aim of our study was to investigate outcome of our CDH patients and to compare it to data in literature. Patients and Methods: 30 patients with perinatally diagnosed CDH were hospitalized at our institution from 1999 - 2017. 3 patients were excluded due to severe comorbidities and redirection of care or failed resuscitation respectively. We divided patients into two groups: Group A included all patients who fulfilled ECMO-criteria (n = 8) and group B included those who did not fulfil any ECMO criteria (n = 19). All our patients were treated without ECMO. Results: Patients in group A had significantly larger defects (p = 0.0104), liver herniation was found more frequently (p = 0.038) and three patients suffer from relevant long-term morbidity (p = 0.009).The overall survival of newborns with CDH (n = 30) was 83%. Survival of patients in group A was 75% and in group B was 100%. Conclusion: Until today the benefit of ECMO to improve survival of newborns with CDH could not be proven. Survival rates of our patients fulfilling ECMO-criteria who were managed with conventional therapy only are not inferior to those treated with ECMO Published in literature. We Therefore conclude that the necessity and indication for ECMO In patients with CDH has to be questioned more critically.