The development of multiorgan dysfunction in CDH-ECMO neonates is associated with the level of pre-ECMO support

Patrick T Delaplain; Louis Ehwerhemuepha; Danh V Nguyen; Matteo Di Nardo; Tim Jancelewicz; Saeed Awan; Peter T Yu; Yigit S Guner; ELSO CDH Interest Group

doi:10.1016/j.jpedsurg.2020.01.026

The development of multiorgan dysfunction in CDH-ECMO neonates is associated with the level of pre-ECMO support

J Pediatr Surg. 2020 May;55(5):830-834. doi: 10.1016/j.jpedsurg.2020.01.026. Epub 2020 Feb 14.

Authors

Patrick T Delaplain¹, Louis Ehwerhemuepha², Danh V Nguyen³, Matteo Di Nardo⁴, Tim Jancelewicz⁵, Saeed Awan⁶, Peter T Yu⁶, Yigit S Guner⁶; ELSO CDH Interest Group

Affiliations

¹ University of California Irvine Medical Center, Department of Surgery, Orange, CA. Electronic address: pdelapla@uci.edu.
² Children's Hospital of Orange County, Information Systems, Orange, CA.
³ University of California, Irvine School of Medicine, Department of Medicine, Orange, CA.
⁴ Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy.
⁵ Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Division of Pediatric Surgery, Memphis, TN.
⁶ University of California Irvine Medical Center, Department of Surgery, Orange, CA; Children's Hospital of Orange County, Information Systems, Orange, CA.

PMID: 32067809
DOI: 10.1016/j.jpedsurg.2020.01.026

Abstract

Purpose: 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).

Methods: 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.

Results: 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.

Conclusions: 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.

Type of study: Treatment study.

Level of evidence: Level III.

Keywords: Congenital diaphragmatic hernia; Extracorporeal life support (ECLS); Extracorporeal membrane oxygenation (ECMO); Multisystem organ failure.

MeSH terms

Extracorporeal Membrane Oxygenation / statistics & numerical data*
Hernias, Diaphragmatic, Congenital* / complications
Hernias, Diaphragmatic, Congenital* / epidemiology
Humans
Infant, Newborn
Multiple Organ Failure* / epidemiology
Multiple Organ Failure* / etiology