Effect of extracorporeal life support on survival when applied to all patients with congenital diaphragmatic hernia

1993 = 14) as has the severity of associated respiratory insufficiency (% of patients with best Paor of ~50 mm Hg: 1981 to 1987 = 8%, 1988 to 1993 = 28%). Overall, the survival rate was lower for patients in the expanded ECLS group (59% v 75%; P = .121). When the survival rates for patients supported with ECLS postoperatively were compared for the expanded and early groups, a significant difference (59% v 80%; P < .05) was noted. However, when ECLS patients with a best Paor of 150 mm Hg were excluded from this analysis, there was no significant difference between the two groups (74% v 80%). indicating that the inclusion of nonhoneymoon patients as potential ECLS candidates has accounted for a significant portion of the observed decrease in survival among CDH patients managed with ECLS. The survival rate of salvageable CDH patients with a best Paor of 550 mm Hg increased slightly for the expanded ECLS group, to 27% (4 of 15). versus 0% (0 of 2) for the early ECLS group. The authors conclude that a change in the population of CDH patients presenting to their institution along with application of ECLS to CDH patients without a honeymoon has resulted in a reduction in the survival rate, but has allowed only a modest 27% survival rate for patients who were previously considered nonsalvageable. Copyrighf o 1994 by W.B. Saunders Company