Congenital diaphragmatic hernia: are improvements in ECMO & survival sustainable over time?

BACKGROUND

Infants with congenital diaphragmatic hernia (CDH) remain at high risk for ECMO and mortality. We previously reported improved outcomes after implementing new CDH care guidelines. This study reassesses ECMO rates, survival, and guideline adherence to determine if improvements persisted.

METHODS

Retrospective review of all neonatal CDH cases at a single center during pre-guideline (2003-2015, n = 229) and post-guideline (2016-2024, n = 160) periods, with post-guideline subdivided into two epochs: post-1 (2016-2019, n = 70) and post-2 (2020-2024, n = 90).

RESULTS

Survival without ECMO improved (pre-53%; post-1 74%; post-2 82%; p < 0.001), as did overall survival (72% vs. 83% vs. 86%; p = 0.006). ECMO use decreased (31% vs. 14% vs. 6%; p < 0.001). Inhaled nitric oxide use remained low, and vasoactive medication use dropped significantly in post-2.

CONCLUSION

Sustained survival improvement and reduced ECMO use followed guideline changes emphasizing minimal stimulation, gentle ventilation, delayed transfer, pre-ductal saturation monitoring, and limited vasoactive therapy.