Proceedings

The Treatment with ECMO of Persistent Fetal Circulation following Repair of Congenital Diaphragmatic Hernia

University of Pittsburgh School of Medicine, Department of Surgery Pittsburgh, Pennsylvania

^* Address communications to: Robert Debski, M.D., University of Pittsburgh School of Medicine, Department of Surgery, 1084 Scaife Hall, Pittsburgh, PA 15261.

Revised: March 1982
Accepted: May 1982

Abstract

Efforts in the animal laboratory over the last four years have been directed toward exploration of the use and improving the techniques of extracorporeal membrane oxygenation (ECMO), anticipating that with greater refinement ECMO might find wider application. As a result of this laboratory experience, the first clinical trials at Children's Hospital of Pittsburgh were undertaken.

Four neonates having undergone repair of a congenital diaphragmatic hernia and developing a persistent fetal circulatory pattern have been supported with prolonged (3 to 9 days) extracorporeal membrane oxygenation between December of 1979 and July of 1980, and three have survived. This encouraging experience indicates that the pattern of persistent fetal circulation in the newborn who has undergone repair of a diaphragmatic hernia can be successfully managed with ECMO even when efforts to lower pulmonary hypertension and improve oxygenation with vasodilators (tolazoline, phenothiazine, acetylcholine, prostaglandin E₁) have been ineffective. The effectiveness and safety of ECMO is convincing enough to warrant its consideration as therapy for congenital diaphragmatic hernia and persistent fetal circulation prior to the use of vasodilators.