Management preferences in ECMO mode for congenital diaphragmatic hernia

Study by ELSO CDH Interest Group

Research output: Contribution to journalArticle

Abstract

PURPOSE: The purpose of this study was to identify management preferences that may exist in the care of infants with CDH receiving ECMO with emphasis on VV-ECMO.

METHODS: A survey was created to measure treatment preferences regarding ECMO use in CDH. The survey was distributed to all APSA and ELSO/Euro-ELSO members via e-mail. Survey results were summarized using descriptive statistics.

RESULTS: The survey had 230 respondents. The survey participants were surgeons (75%), neonatologists/intensivists (23%), and "other" (2%). The mean annual center volume was 11.6(±9.6) CDH cases, and the average number treated with ECMO was 4.5 (±6.4) cases/yr. The most agreed upon criteria for ECMO initiation were preductal O2 saturation <80% refractory to ventilator manipulation and medical therapy (89%), oxygenation index >40 (80%), severe air-leak (79%), and mixed acidosis (75%). Over 60% of respondents agreed the VV-ECMO would be optimum for average risk neonates. However, this preference diminished as the pre-ECMO level of cardiac support increased. When asked about why each respondent would choose VA-ECMO over VV-ECMO, the responses varied significantly between surgeons and non-surgeons.

CONCLUSION: While there seem to be areas of consensus among practitioners, such as criteria for initiation of ECMO, this survey revealed substantial variation in individual practice patterns regarding the use of ECMO for CDH.

TYPE OF STUDY: Qualitative, Survey.

LEVEL OF EVIDENCE: IV.

Original languageEnglish
JournalJournal of Pediatric Surgery
DOIs
Publication statusE-pub ahead of print - Jan 31 2019

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Surveys and Questionnaires
Congenital Diaphragmatic Hernias
Infant Care
Postal Service
Acidosis
Air
Newborn Infant
Surgeons
Therapeutics
Neonatologists

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Management preferences in ECMO mode for congenital diaphragmatic hernia. / Study by ELSO CDH Interest Group.

In: Journal of Pediatric Surgery, 31.01.2019.

Research output: Contribution to journalArticle

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abstract = "PURPOSE: The purpose of this study was to identify management preferences that may exist in the care of infants with CDH receiving ECMO with emphasis on VV-ECMO.METHODS: A survey was created to measure treatment preferences regarding ECMO use in CDH. The survey was distributed to all APSA and ELSO/Euro-ELSO members via e-mail. Survey results were summarized using descriptive statistics.RESULTS: The survey had 230 respondents. The survey participants were surgeons (75{\%}), neonatologists/intensivists (23{\%}), and {"}other{"} (2{\%}). The mean annual center volume was 11.6(±9.6) CDH cases, and the average number treated with ECMO was 4.5 (±6.4) cases/yr. The most agreed upon criteria for ECMO initiation were preductal O2 saturation <80{\%} refractory to ventilator manipulation and medical therapy (89{\%}), oxygenation index >40 (80{\%}), severe air-leak (79{\%}), and mixed acidosis (75{\%}). Over 60{\%} of respondents agreed the VV-ECMO would be optimum for average risk neonates. However, this preference diminished as the pre-ECMO level of cardiac support increased. When asked about why each respondent would choose VA-ECMO over VV-ECMO, the responses varied significantly between surgeons and non-surgeons.CONCLUSION: While there seem to be areas of consensus among practitioners, such as criteria for initiation of ECMO, this survey revealed substantial variation in individual practice patterns regarding the use of ECMO for CDH.TYPE OF STUDY: Qualitative, Survey.LEVEL OF EVIDENCE: IV.",
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AU - Study by ELSO CDH Interest Group

AU - Delaplain, Patrick T

AU - Jancelewicz, Tim

AU - Di Nardo, Matteo

AU - Zhang, Lishi

AU - Yu, Peter T

AU - Cleary, John P

AU - Morini, Francesco

AU - Harting, Matthew T

AU - Nguyen, Danh V

AU - Guner, Yigit S

N1 - Copyright © 2019 Elsevier Inc. All rights reserved.

PY - 2019/1/31

Y1 - 2019/1/31

N2 - PURPOSE: The purpose of this study was to identify management preferences that may exist in the care of infants with CDH receiving ECMO with emphasis on VV-ECMO.METHODS: A survey was created to measure treatment preferences regarding ECMO use in CDH. The survey was distributed to all APSA and ELSO/Euro-ELSO members via e-mail. Survey results were summarized using descriptive statistics.RESULTS: The survey had 230 respondents. The survey participants were surgeons (75%), neonatologists/intensivists (23%), and "other" (2%). The mean annual center volume was 11.6(±9.6) CDH cases, and the average number treated with ECMO was 4.5 (±6.4) cases/yr. The most agreed upon criteria for ECMO initiation were preductal O2 saturation <80% refractory to ventilator manipulation and medical therapy (89%), oxygenation index >40 (80%), severe air-leak (79%), and mixed acidosis (75%). Over 60% of respondents agreed the VV-ECMO would be optimum for average risk neonates. However, this preference diminished as the pre-ECMO level of cardiac support increased. When asked about why each respondent would choose VA-ECMO over VV-ECMO, the responses varied significantly between surgeons and non-surgeons.CONCLUSION: While there seem to be areas of consensus among practitioners, such as criteria for initiation of ECMO, this survey revealed substantial variation in individual practice patterns regarding the use of ECMO for CDH.TYPE OF STUDY: Qualitative, Survey.LEVEL OF EVIDENCE: IV.

AB - PURPOSE: The purpose of this study was to identify management preferences that may exist in the care of infants with CDH receiving ECMO with emphasis on VV-ECMO.METHODS: A survey was created to measure treatment preferences regarding ECMO use in CDH. The survey was distributed to all APSA and ELSO/Euro-ELSO members via e-mail. Survey results were summarized using descriptive statistics.RESULTS: The survey had 230 respondents. The survey participants were surgeons (75%), neonatologists/intensivists (23%), and "other" (2%). The mean annual center volume was 11.6(±9.6) CDH cases, and the average number treated with ECMO was 4.5 (±6.4) cases/yr. The most agreed upon criteria for ECMO initiation were preductal O2 saturation <80% refractory to ventilator manipulation and medical therapy (89%), oxygenation index >40 (80%), severe air-leak (79%), and mixed acidosis (75%). Over 60% of respondents agreed the VV-ECMO would be optimum for average risk neonates. However, this preference diminished as the pre-ECMO level of cardiac support increased. When asked about why each respondent would choose VA-ECMO over VV-ECMO, the responses varied significantly between surgeons and non-surgeons.CONCLUSION: While there seem to be areas of consensus among practitioners, such as criteria for initiation of ECMO, this survey revealed substantial variation in individual practice patterns regarding the use of ECMO for CDH.TYPE OF STUDY: Qualitative, Survey.LEVEL OF EVIDENCE: IV.

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DO - 10.1016/j.jpedsurg.2019.01.019

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JO - Journal of Pediatric Surgery

JF - Journal of Pediatric Surgery

SN - 0022-3468

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