PMID- 30318280
OWN - NLM
STAT- MEDLINE
DCOM- 20181211
LR  - 20230928
IS  - 1531-5037 (Electronic)
IS  - 0022-3468 (Print)
IS  - 0022-3468 (Linking)
VI  - 53
IP  - 11
DP  - 2018 Nov
TI  - Outcomes of infants with congenital diaphragmatic hernia treated with venovenous 
      versus venoarterial extracorporeal membrane oxygenation: A propensity score 
      approach.
PG  - 2092-2099
LID - S0022-3468(18)30375-0 [pii]
LID - 10.1016/j.jpedsurg.2018.06.003 [doi]
AB  - PURPOSE: Previous studies comparing extracorporeal membrane oxygenation (ECMO) 
      modality for congenital diaphragmatic hernia (CDH) have not accounted for 
      confounding by indication. We therefore hypothesized that using a propensity 
      score (PS) approach to account for selection bias may identify outcome 
      differences based on ECMO modality for infants with CDH. METHODS: We utilized 
      ELSO Registry data (2000-2016). Patients with CDH were divided to either 
      venoarterial (VA) or venovenous (VV) ECMO. Patients were matched by PS to control 
      for nonrandom treatment assignment. Subgroup analyses were conducted based on 
      timing of CDH repair relative to ECMO. Primary analysis was the "intent-to-treat" 
      cohort based on the initial ECMO mode. Mortality was the primary outcome, and 
      severe neurologic injury (SNI) was a secondary outcome. RESULTS: PS matching 
      (3:1) identified 3304 infants (VA = 2470, VV = 834). In the main group, mortality 
      was not different between VA and VV ECMO (OR = 1.01, 95% CI: 0.86-1.18) and there 
      was no difference in SNI between VA and VV (OR = 0.80; 95% CI: 0.63-1.01). For 
      the pre-ECMO CDH repair subgroup, 175 VA cases were matched to 70 VV. In these 
      neonates, mortality was higher for VV compared to VA (OR = 2.10, 95% CI: 
      1.19-3.69), without any difference in SNI (OR = 1.48; 95% CI: 0.59-3.71). For the 
      subgroup that did not have pre-ECMO CDH repair, 2030 VA cases were matched to 683 
      VV cases. In this subgroup, VV was associated with 27% lower risk of SNI relative 
      to VA (OR = 0.73, 95% CI: 0.56-0.95) without any difference in mortality 
      (OR = 0.94, 95% CI: 0.79-1.11). CONCLUSION: This study revalidates that ECMO mode 
      does not significantly affect mortality or SNI in infants with CDH. In the subset 
      of infants who require pre-ECMO CDH repair, VA favors survival, whereas, in the 
      subgroup of infants that did not have pre-ECMO CDH repair, VV favors lower rates 
      of SNI. We conclude that neither mode appears consistently superior across all 
      situations, and clinical judgment should remain a multifactorial decision. LEVEL 
      OF EVIDENCE: Level III.
CI  - Copyright (c) 2018 Elsevier Inc. All rights reserved.
FAU - Guner, Yigit S
AU  - Guner YS
AD  - Children's Hospital of Orange County, Division of Pediatric Surgery, Orange, CA; 
      University of California Irvine Medical Center, Department of Surgery, Orange, 
      CA. Electronic address: yguner@uci.edu.
FAU - Harting, Matthew T
AU  - Harting MT
AD  - Department of Pediatric Surgery, University of Texas McGovern Medical School and 
      Children's Memorial Hermann Hospital, Houston, TX.
FAU - Fairbairn, Kelly
AU  - Fairbairn K
AD  - Community Memorial Hospital, Department of Surgery, Ventura, CA.
FAU - Delaplain, Patrick T
AU  - Delaplain PT
AD  - University of California Irvine Medical Center, Department of Surgery, Orange, 
      CA; Children's Hospital Los Angeles, Department of Pediatric Surgery.
FAU - Zhang, Lishi
AU  - Zhang L
AD  - University of California Irvine Biostatistics, Institute for Clinical and 
      Translational Science Irvine, CA.
FAU - Chen, Yanjun
AU  - Chen Y
AD  - University of California Irvine Biostatistics, Institute for Clinical and 
      Translational Science Irvine, CA.
FAU - Kabeer, Mustafa H
AU  - Kabeer MH
AD  - Children's Hospital of Orange County, Division of Pediatric Surgery, Orange, CA; 
      University of California Irvine Medical Center, Department of Surgery, Orange, 
      CA.
FAU - Yu, Peter
AU  - Yu P
AD  - Children's Hospital of Orange County, Division of Pediatric Surgery, Orange, CA; 
      University of California Irvine Medical Center, Department of Surgery, Orange, 
      CA.
FAU - Cleary, John P
AU  - Cleary JP
AD  - Children's Hospital of Orange County, Division of Neonatalogy, Orange, CA.
FAU - Stein, James E
AU  - Stein JE
AD  - Children's Hospital Los Angeles, Department of Pediatric Surgery.
FAU - Stolar, Charles
AU  - Stolar C
AD  - Columbia University College of Physicians and Surgeons, New York City, New York; 
      California Pediatric Surgical Group, Santa Barbara.
FAU - Nguyen, Danh V
AU  - Nguyen DV
AD  - University of California, Irvine School of Medicine, Department of Medicine, 
      Orange, CA.
LA  - eng
GR  - UL1 TR001414/TR/NCATS NIH HHS/United States
PT  - Journal Article
DEP - 20180607
PL  - United States
TA  - J Pediatr Surg
JT  - Journal of pediatric surgery
JID - 0052631
SB  - IM
MH  - Extracorporeal Membrane Oxygenation/*mortality/statistics & numerical data
MH  - *Hernias, Diaphragmatic, Congenital/epidemiology/mortality/therapy
MH  - Humans
MH  - Infant
MH  - Propensity Score
MH  - Retrospective Studies
MH  - Treatment Outcome
PMC - PMC6192269
MID - NIHMS974244
OTO - NOTNLM
OT  - CDH
OT  - ECMO
OT  - Propensity score
OT  - Venoarterial
OT  - Venovenous
EDAT- 2018/10/16 06:00
MHDA- 2018/12/12 06:00
PMCR- 2019/11/01
CRDT- 2018/10/16 06:00
PHST- 2017/11/21 00:00 [received]
PHST- 2018/04/18 00:00 [revised]
PHST- 2018/06/03 00:00 [accepted]
PHST- 2018/10/16 06:00 [entrez]
PHST- 2018/10/16 06:00 [pubmed]
PHST- 2018/12/12 06:00 [medline]
PHST- 2019/11/01 00:00 [pmc-release]
AID - S0022-3468(18)30375-0 [pii]
AID - 10.1016/j.jpedsurg.2018.06.003 [doi]
PST - ppublish
SO  - J Pediatr Surg. 2018 Nov;53(11):2092-2099. doi: 10.1016/j.jpedsurg.2018.06.003. 
      Epub 2018 Jun 7.