AI Article Synopsis
- CDH management varies significantly across medical centers, leading to different patient outcomes and a study aimed to analyze survival rates and ECMO use at a single center.
- The study reviewed 81 CDH patients treated from 2004-2017, finding that ECMO treatment was linked to higher mortality rates compared to a larger registry, with socio-economic factors showing no significant impact on outcomes.
- Results indicated that ECMO use was more predictive of mortality than the severity of CDH itself, particularly revealing an overuse of ECMO in lower-risk patients, highlighting a need for better risk stratification in assessing treatment effectiveness.
Article Abstract
Background: Management of CDH is highly variable from center to center, as are patient outcomes. The purpose of this study was to examine risk-stratified survival and extracorporeal membrane oxygenation (ECMO) rates at a single center, and to determine whether adverse outcomes are related to patient characteristics or management.
Methods: A retrospective single-center review of CDH patients was performed, and outcomes compared to those reported by the CDH Study Group (CDHSG) registry. Patient demographics, disparities, and clinical characteristics were examined to identify unique features of the cohort. A model derived using the registry that estimates probability of ECMO use or death in CDH newborns was used to risk-stratify patients and assess mortality rates. Observed over expected (O/E) ECMO use rates were calculated to measure whether "excess" or "appropriate" ECMO use was occurring.
Results: There were 81 CDH patients treated between 2004-2017, and 5034 in the CDHSG registry. Mortality in ECMO-treated patients was higher than the registry. Socioeconomic variables were not significantly associated with outcomes. The strongest predictors of mortality were ECMO use and early blood gas variables. The risk model accurately predicted ECMO use with a c-statistic of 0.79. Compared with the registry, the disparity in mortality rates was greatest for moderate-risk patients. O/E ECMO use was highest in low and moderate-risk patients.
Conclusions: ECMO use is a more consistent predictor of mortality than CDH severity at a single center, and there is relative overuse of ECMO in lower-risk patients. Risk stratification allows for more accurate institutional assessment of mortality and ECMO use, and other centers could consider such an adjusted analysis to identify opportunities for outcomes improvement.
Level Of Evidence: III.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.jpedsurg.2019.01.020 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Multi-disciplinary treatment of broncho-esophageal fistula in a high-risk single-lung patient.
J Cardiothorac Surg
January 2025
Section of Cardiothoracic Surgery, Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway.
Background: A broncho-esophageal fistula (BEF) is a medical and surgical disaster. Treatment of BEF is often limited to palliative stent treatment that may migrate or cause erosions and tissue necrosis. Surgical repair of BEF is the only established definite treatment.
View Article and Find Full Text PDFFrom Escalate to Elevate: A New Paradigm for Comprehensive Cardiogenic Shock Management.
Can J Cardiol
January 2025
Ted Rogers Centre for Heart Research, University Health Network, Toronto, ON, Canada; Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada. Electronic address:
Patients with cardiogenic shock (CS) present with critical hemodynamic compromise with low cardiac output (CO) resulting in end-organ dysfunction. Prognosis is closely related to the severity of shock and treatment of patients with CS is resource intensive. In this review, we consider the current treatment paradigms alongside the evidence that underpins them.
View Article and Find Full Text PDFThe Management of Postpartum Cardiorespiratory Failure in a Patient with COVID-19 and Sickle Cell Trait Requiring Extraorporeal Membrane Oxygenation Support and Airflight Transportation.
J Clin Med
January 2025
Department of Cardiovascular & Thoracic Anaesthesia and Critical Care, University Hospital of Martinique, F-97200 Fort-de-France, Martinique, France.
Acute cardiovascular disorders are incriminated in up to 33% of maternal deaths, and the presence of sickle cell anemia (SCA) aggravates the risk of peripartum complications. Herein, we present a 24-year-old Caribbean woman with known SCA who developed a vaso-occlusive crisis at 36 weeks of gestation that required emergency Cesarean section. In the early postpartum period, she experienced fever with rapid onset of acute respiratory distress in the context of COVID-19 infection that required tracheal intubation and mechanical ventilatory support with broad-spectrum antibiotics and blood exchange transfusion.
View Article and Find Full Text PDFLocal Anesthetic Infiltration, Awake Veno-Venous Extracorporeal Membrane Oxygenation, and Airway Management for Resection of a Giant Mediastinal Cyst: A Narrative Review and Case Report.
J Clin Med
December 2024
Anesthesiology and Operative Intensive Care, Faculty of Medicine, University of Augsburg, 86156 Augsburg, Germany.
Mediastinal mass syndrome represents a major threat to respiratory and cardiovascular integrity, with difficult evidence-based risk stratification for interdisciplinary management. We conducted a narrative review concerning risk stratification and difficult airway management of patients presenting with a large mediastinal mass. This is supplemented by a case report illustrating our individual approach for a patient presenting with a subtotal tracheal stenosis due to a large cyst of the thyroid gland.
View Article and Find Full Text PDFPredictive Potential of ECMO Blood Flow for Hemolysis and Outcome of Patients with Severe ARDS.
J Clin Med
December 2024
Department of Anesthesiology and Intensive Care Medicine CCM/CVK Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 13353 Berlin, Germany.
Treatment with veno-venous extracorporeal membrane oxygenation (VV ECMO) has become a frequently considered rescue therapy in patients with severe acute respiratory distress syndrome (ARDS). Hemolysis is a common complication in patients treated with ECMO. Currently, it is unclear whether increased ECMO blood flow (Q̇) contributes to mortality and might be associated with increased hemolysis.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!