Abstract
Study objectives: We reviewed the use of and indications for therapeutic bronchoscopy in congenital diaphragmatic hernia (CDH) patients requiring ECMO; timing, frequency, and complications of the intervention during ECMO run; and outcome. Design: Retrospective study. Setting: Neonatal intensive care unit (NICU) of a university children‘s hospital. Patients: All CDH patients requiring ECMO from 1/1/1996 to 12/31/2000. Measurements and Results: A total of 17 patients with CDH were placed on ECMO during the period examined, all before repair. Of those, eight received therapeutic bronchoscopy. The major indication for bronchoscopy in all cases was persistent atelectasis or collapse consistent with mucus plugging. The number of bronchoscopy procedures performed in each case ranged from 1 to 4. Temporally-related radiographic improvements were seen in the majority of cases after one or two procedures. Seven of the eight patients underwent first bronchoscopy after CDH repair. Both acetylcysteine (Mucomyst®) and beractant were used during bronchoscopy in selected cases. Complications were limited to minor bleeding, which was easily controlled. All patients who received therapeutic bronchoscopy survived decannulation, although one infant with neurologic and renal abnormalities died at 4 months. Conclusions: In this small number of patients with CDH requiring ECMO, bronchoscopy appeared to be safe and efficacious. Clearly, the outcome of patients with CDH requiring ECMO is influenced by numerous and complex factors. This preliminary report suggests the need for larger randomized controlled trials of bronchoscopy in this population to assess whether this intervention could result in shorter ECMO runs or improved outcomes.