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Mortality Prediction in Infants with Congenital Diaphragmatic Hernia: Potential Criteria for ECMO

Over the last ten years the survival of infants born with congenital diaphragmatic hernia who reach the Intensive Care Unit of the Royal Children's Hospital, Melbourne has been constant at 56±6%. Experimental therapies such as extracorporeal membrane oxygenation, high-frequency oscillation and lung transplantation are now being considered as therapeutic options, and as such the ability to predict survival or death of these infants is increasingly important. The records of all infants with congenital diaphragmatic hernia admitted to the Intensive Care Unit between 1 January 1980 and 30 April 1989 were reviewed; blood gas, ventilatory details, and outcome information was obtained. Receiver operating curve analysis was used to determine the best predictor of death. An oxygenation index (MAP X Fio2/Pao2) > 0.3 or ventilation index (PIP X RR X CO2/1000) > 70 predicted a 94% mortality with a specificity of 96% and a sensitivity of 82%.