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Trends in Mortality and Risk Characteristics of Congenital Diaphragmatic Hernia Treated With Extracorporeal Membrane Oxygenation

Although the mortality of infants with congenital diaphragmatic hernia (CDH) has been improving since the late 1990s, this observation has not been paralleled among the CDH cohort receiving extracorporeal membrane oxygenation (ECMO). We sought to elucidate why the mortality rate in the CDH-ECMO popu...

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Autores principales: Guner, Yigit S., Delaplain, Patrick T., Zhang, Lishi, Di Nardo, Matteo, Brogan, Thomas V., Chen, Yanjun, Cleary, John P., Yu, Peter T, Harting, Matthew T., Ford, Henri R., Nguyen, Danh V.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6251767/
https://www.ncbi.nlm.nih.gov/pubmed/29863628
http://dx.doi.org/10.1097/MAT.0000000000000834
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author Guner, Yigit S.
Delaplain, Patrick T.
Zhang, Lishi
Di Nardo, Matteo
Brogan, Thomas V.
Chen, Yanjun
Cleary, John P.
Yu, Peter T
Harting, Matthew T.
Ford, Henri R.
Nguyen, Danh V.
author_facet Guner, Yigit S.
Delaplain, Patrick T.
Zhang, Lishi
Di Nardo, Matteo
Brogan, Thomas V.
Chen, Yanjun
Cleary, John P.
Yu, Peter T
Harting, Matthew T.
Ford, Henri R.
Nguyen, Danh V.
author_sort Guner, Yigit S.
collection PubMed
description Although the mortality of infants with congenital diaphragmatic hernia (CDH) has been improving since the late 1990s, this observation has not been paralleled among the CDH cohort receiving extracorporeal membrane oxygenation (ECMO). We sought to elucidate why the mortality rate in the CDH-ECMO population has remained at approximately 50% despite consistent progress in the field by examining the baseline risk profile/characteristics of neonates with CDH before ECMO (pre-ECMO). Neonates with a diagnosis of CDH were identified in the Extracorporeal Life Support Organization (ELSO) Registry from 1992 to 2015. Individual pre-ECMO risk score (RS) for mortality was categorized to pre-ECMO risk-stratified cohorts. Temporal trends based on individual-level mortality by risk cohorts were assessed by logistic regression. We identified 6,696 neonates with CDH. The mortality rates during this time period were approximately 50%. The average baseline pre-ECMO RS increased during this period: mean increase of 0.35 (95% confidence interval [CI]: 0.324–0.380). In the low-risk cohort, the likelihood of mortality increased over time: each 5 year change was associated with a 7.3% increased likelihood of mortality (odds ratio [OR]: 1.0726; 95% CI: 1.0060–1.1437). For the moderate-risk cohort, the likelihood of mortality decreased by 7.05% (OR: 0.9295; 95% CI: 0.8822–0.9793). There was no change in the odds of mortality for the high-risk cohort (OR: 0.9650; 95% CI: 0.8915–1.0446). Although the overall mortality rate remained approximately constant over time, the individual likelihood of death has declined over time in the moderate-risk cohort, increased in the low-risk cohort, and remained unchanged in the high-risk cohort.
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spelling pubmed-62517672019-07-22 Trends in Mortality and Risk Characteristics of Congenital Diaphragmatic Hernia Treated With Extracorporeal Membrane Oxygenation Guner, Yigit S. Delaplain, Patrick T. Zhang, Lishi Di Nardo, Matteo Brogan, Thomas V. Chen, Yanjun Cleary, John P. Yu, Peter T Harting, Matthew T. Ford, Henri R. Nguyen, Danh V. ASAIO J Pediatric Circulatory Support Although the mortality of infants with congenital diaphragmatic hernia (CDH) has been improving since the late 1990s, this observation has not been paralleled among the CDH cohort receiving extracorporeal membrane oxygenation (ECMO). We sought to elucidate why the mortality rate in the CDH-ECMO population has remained at approximately 50% despite consistent progress in the field by examining the baseline risk profile/characteristics of neonates with CDH before ECMO (pre-ECMO). Neonates with a diagnosis of CDH were identified in the Extracorporeal Life Support Organization (ELSO) Registry from 1992 to 2015. Individual pre-ECMO risk score (RS) for mortality was categorized to pre-ECMO risk-stratified cohorts. Temporal trends based on individual-level mortality by risk cohorts were assessed by logistic regression. We identified 6,696 neonates with CDH. The mortality rates during this time period were approximately 50%. The average baseline pre-ECMO RS increased during this period: mean increase of 0.35 (95% confidence interval [CI]: 0.324–0.380). In the low-risk cohort, the likelihood of mortality increased over time: each 5 year change was associated with a 7.3% increased likelihood of mortality (odds ratio [OR]: 1.0726; 95% CI: 1.0060–1.1437). For the moderate-risk cohort, the likelihood of mortality decreased by 7.05% (OR: 0.9295; 95% CI: 0.8822–0.9793). There was no change in the odds of mortality for the high-risk cohort (OR: 0.9650; 95% CI: 0.8915–1.0446). Although the overall mortality rate remained approximately constant over time, the individual likelihood of death has declined over time in the moderate-risk cohort, increased in the low-risk cohort, and remained unchanged in the high-risk cohort. Lippincott Williams & Wilkins 2019-07 2019-05-23 /pmc/articles/PMC6251767/ /pubmed/29863628 http://dx.doi.org/10.1097/MAT.0000000000000834 Text en Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the ASAIO. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY) (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Pediatric Circulatory Support
Guner, Yigit S.
Delaplain, Patrick T.
Zhang, Lishi
Di Nardo, Matteo
Brogan, Thomas V.
Chen, Yanjun
Cleary, John P.
Yu, Peter T
Harting, Matthew T.
Ford, Henri R.
Nguyen, Danh V.
Trends in Mortality and Risk Characteristics of Congenital Diaphragmatic Hernia Treated With Extracorporeal Membrane Oxygenation
title Trends in Mortality and Risk Characteristics of Congenital Diaphragmatic Hernia Treated With Extracorporeal Membrane Oxygenation
title_full Trends in Mortality and Risk Characteristics of Congenital Diaphragmatic Hernia Treated With Extracorporeal Membrane Oxygenation
title_fullStr Trends in Mortality and Risk Characteristics of Congenital Diaphragmatic Hernia Treated With Extracorporeal Membrane Oxygenation
title_full_unstemmed Trends in Mortality and Risk Characteristics of Congenital Diaphragmatic Hernia Treated With Extracorporeal Membrane Oxygenation
title_short Trends in Mortality and Risk Characteristics of Congenital Diaphragmatic Hernia Treated With Extracorporeal Membrane Oxygenation
title_sort trends in mortality and risk characteristics of congenital diaphragmatic hernia treated with extracorporeal membrane oxygenation
topic Pediatric Circulatory Support
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6251767/
https://www.ncbi.nlm.nih.gov/pubmed/29863628
http://dx.doi.org/10.1097/MAT.0000000000000834
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