Entry criteria for extracorporeal membrane oxygenation in neonates with congenital diaphragmatic hernia treated with high-frequency oscillatory ventilation

Abstract

Although respiratory management with high-frequency oscillatory ventilation (HFOV) has generally been used for neonates with congenital diaphragmatic hernia (CDH), entry criteria for extracorporeal membrane oxygenation (ECMO) based on data from patients who underwent HFOV have not yet been reported. To establish entry criteria for ECMO in such patients, we retrospectively studied 36 neonates with CDH treated by HFOV in our institutions between 1986 and 1994. From the admission records, preductal and postductal arterial blood gas data and HFOV ventilation conditions for 72 h after admission were extracted. Oxygenation index (OI) and alveolar-arterial oxygen gradient (A-aDO2) time interval combinations were calculated. Patients were divided into two groups: candidates for ECMO (n = 22) who underwent ECMO (n = 18) or died without ECMO (n = 4); and non-candidates (n = 14), who survived without ECMO. Blood gas data in patients placed on ECMO were comparable to those in patients who died without ECMO: mean pre- and postductal OI for 4 h > 30, postductal A-aD02 ≤ 620 mmHg for 4 h, postductal A-aD02 ≤ 580 mmHg for 8 h, and postductal A-aDO2 ≤ 550 mmHg for 12 h showed better sensitivity with a specificity of more than 90% compared to entry criteria that had previously been used in our institutions: a postductal OI > 40 for 4 h and postductal A-aD02 ≤ 610 mmHg for 8 h. In addition, a combination of pre- and postductal OI > 30 for 4 h indicated a sensitivity of 95.5% and a specificity of 92.9%.