29 - Standardized management of infants with CDH reduces the need for cardiorespiratory support including ECMO and improves overall survival at discharge

Poster Number: 29
Publication Number: 29.102

Katrin Lichtsinn, UPMC Childrens Hospital of Pittsburgh, PITTSBURGH, PA, United States; Paul Waltz, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States; Joseph Church, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States; Abeer Azzuqa, UPMC Childrens Hospital of Pittsburgh, Sewickley, PA, United States; Jacqueline Graham, Children's Hospital, Pittsburgh, PA, United States; Jennifer Troutman, Children’s Hospital of Pittsburgh, Cheswick, PA, United States; Burhan Mahmood, UPMC Childrens Hospital of Pittsburgh, Pittburgh, PA, United States

Background: Infants with congenital diaphragmatic hernia (CDH) are critically ill due to pulmonary hypoplasia with high risk of death and/or requiring extracorporeal membrane oxygenation (ECMO). Studies show that consistent clinical practice guidelines (CPGs) improve outcomes in infants with a variety of conditions including CDH. In January 2012 our institution implemented a standardized CPG to manage infants with CDH emphasizing a consistent respiratory approach to minimize lung injury.

Objective: To assess the impact of the CPG on cardiorespiratory and clinical outcomes in patients with CDH. We hypothesized that a consistent approach to manage infants with CDH can reduce ECMO need and improve cardiorespiratory and clinical outcomes including survival at discharge.

Design/Methods: Retrospective chart review of patients with CDH admitted from January 2007 to July 2021 (Nf133). Patients were divided into two cohorts. Cohort 1 (management not standardized): January 2007 to December 2011 (Nf53). Cohort 2 (management standardized): January 2012 to July 2021 (Nf80). Descriptive statistics were used to compare the cohorts including survivors vs non-survivors and ECMO vs non-ECMO patients.

Results: Patient demographics, antenatal diagnosis, hernia side, liver herniation, pre-operative pneumothorax, admission pCO2, timing and type of surgical repair were not statistically different between cohorts. Cohort 1 also had significantly more severe pulmonary hypertension (PH) with greater need for sildenafil, vasopressors, and iNO therapy than Cohort 2 (p < 0.001). Cohort 1 had significantly more total ventilator (p < 0.001) and supplemental oxygen days (p=0.016). ECMO rates were significantly higher in Cohort 1 (p < 0.001) while survival at discharge was significantly lower in Cohort 1 compared to Cohort 2 (p < 0.001). Survival at discharge for non-ECMO-treated patients was high and not significantly different between the cohorts. Survival for ECMO-treated patients in Cohort 1 was significantly lower than Cohort 2 (p < 0.01). Cohort 1 patients were more likely to be discharged on gavage feeds, gastroesophageal reflux therapy, and PH medications (p < 0.01). Day of life at discharge, diagnosis of chronic lung disease, and need for home oxygen or tracheostomy/ventilator at discharge were not significantly different between the cohorts.Conclusion(s): Standardized management of infants with CDH can reduce the need for cardiorespiratory support including ECMO and improve survival at discharge. Ongoing refinement of management strategies, particularly cardiorespiratory care can further enhance outcomes in patients with more severe disease.
Lichtsinn CVCV PAS.pdf
ECMO and Non-ECMO Survival at DischargeSurvival for patients who required ECMO in Cohort 1 was significantly lower than in Cohort 2. Survival for patients who did not require ECMO was high and not significantly different between Cohorts.