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Chapter 34 - Extracorporeal Membrane Oxygenation

from Section 6 - Heart Failure, Mechanical Circulatory Support, and Transplantation

Published online by Cambridge University Press:  09 September 2021

By
Rita Saynhalath  and
M. Iqbal Ahmed
Edited by
Laura K. Berenstain  and
James P. Spaeth
Laura K. Berenstain
Affiliation:
Cincinnati Children's Hospital Medical Center
James P. Spaeth
Affiliation:
Cincinnati Children's Hospital Medical Center
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Summary

A congenital diaphragmatic hernia is a rare birth defect characterized by a diaphragmatic defect allowing herniation of abdominal contents into the chest, subsequently impeding normal lung development. This results in structural and functional changes to lung structure, pulmonary circulation, and the heart. The size of the defect can significantly affect the prognosis, as the severity of this condition is proportional to the severity of lung hypoplasia and pulmonary hypertension. Initiation of extracorporeal membrane oxygenation is considered a last resort, life-preserving option for neonates with congenital diaphragmatic hernia who have failed all other medical therapies. This chapter details the management of an infant with congenital diaphragmatic hernia, currently on extracorporeal membrane oxygenation support and requiring repair of his hernia.

Keywords

congenital diaphragmatic herniaextracorporeal membrane oxygenation support (ECMO) circuitintraoperative bleeding on ECMOnon-OR anesthesia
Type
Chapter
Information
Congenital Cardiac Anesthesia
A Case-based Approach
 , pp. 261 - 267
Publisher: Cambridge University Press
Print publication year: 2021

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References

References

Hedrick, H. L., Danzer, E., Merchant, A. M., et al. Liver position and lung-to-head ratio for prediction of extracorporeal membrane oxygenation and survival in isolated left congenital diaphragmatic hernia. Am J Obstet Gynecol 2007; 197: 422.e1–4.CrossRefGoogle ScholarPubMed
Mullassery, D., Ba’ath, M. E., Jesudason, E. C., et al. Value of liver herniation in prediction of outcome in fetal congenital diaphragmatic hernia: a systematic review and meta-analysis. Ultrasound Obstet Gynecol 2010; 35: 609–14.CrossRefGoogle ScholarPubMed
Snoek, K. G., Reiss, I. K. M., Greenough, A., et al. Standardized postnatal management of infants with congenital diaphragmatic hernia in Europe: The CDH EURO Consortium Consensus – 2015 Update. Neonatology 2016; 110: 66–74.CrossRefGoogle Scholar
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Dassinger, M. S., Copeland, D. R., Gossett, J., et al. Early repair of congenital diaphragmatic hernia on extracorporeal membrane oxygenation. J Pediatr Surg 2010: 45: 693–7.CrossRefGoogle ScholarPubMed
Fallon, S. C., Cass, D. L., Olutoye, O. O., et al. Repair of congenital diaphragmatic hernias on extracorporeal membrane oxygenation (ECMO): does early repair improve patient survival? J Pediatr Surg 2013; 48: 1172–6.CrossRefGoogle ScholarPubMed
Gray, B., Rintoul, N.. Extracorporeal life support organization (ELSO) guidelines for neonatal respiratory failure supplement to the ELSO General Guidelines, Version 1. December 4, 2017, Ann Arbor, MI.Google Scholar

Suggested Reading

Chatterjee, D., Ing, R. J., and Gien, J. Update on congenital diaphragmatic hernia. Anesth Analg 2020 Sep; 131(3): 808–821. doi: 10.1213/ANE.0000000000004324CrossRefGoogle Scholar
Jenks, C. L., Raman, L., and Dalton, H. J. Pediatric extracorporeal membrane oxygenation. Crit Care Clin 2017; 33: 825–41.CrossRefGoogle ScholarPubMed
Lequier, L. L., Horton, S. B., McMullan, D. M., et al. Extracorporeal membrane oxygenation circuitry. Pediatr Crit Care Med 2013; 14: S7–12.CrossRefGoogle ScholarPubMed

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