医学
先天性膈疝
体外膜肺氧合
胃造口术
围手术期
外科
抢救疗法
气管软化
胎儿
怀孕
遗传学
生物
气道
作者
Jason Gien,John P. Kinsella,Nicholas Behrendt,Michael Zaretsky,Henry L. Galan,Kenneth W. Liechty
标识
DOI:10.1038/s41372-022-01397-3
摘要
BackgroundSurvival for severe (observed to expected lung-head ratio (O:E LHR) < 25%) congenital diaphragmatic hernia (CDH) remains a challenge (15–25%). Management strategies have focused on fetal endoscopic tracheal occlusion (FETO) and/or extracorporeal membrane oxygenation therapy (ECMO) utilization.Objective(s)Describe single center outcomes for infants with severe CDH.Study designObservational study of 13 severe CDH infants managed with ECMO, a protocolized DR algorithm, and early repair on ECMO with an innovative perioperative anticoagulation strategy.Results13/140 (9.3%) infants met criteria and were managed with ECMO. 77% survived ECMO and 69% survived to discharge. 22% underwent tracheostomy. Median days on mechanical ventilation was 39 days (IQR 22:107.5) and length of stay 135 days (IQR 62.5:211.5). All infants received a gastrostomy tube (GT) and were discharged home on oxygen and pulmonary hypertension (PH) meds.ConclusionSurvival for infants with severe CDH can be optimized with early aggressive intervention and protocolized algorithms (149).
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