Impact of Neonatal Ventilation Mode on Outcomes in Patients With Congenital Diaphragmatic Hernia Treated With Extracorporeal Life Support: A Propensity Score Analysis

High-frequency oscillatory ventilation (HFOV) is used in neonates with hypoxic respiratory failure both as a primary mode and as a rescue mode of ventilation. It is unknown to what degree the use of HFOV provides a measurable benefit to infants with congenital diaphragmatic hernia (CDH) receiving extracorporeal life support (ECLS). We sought to determine whether pre-ECLS use of HFOV compared to conventional mechanical ventilation (CMV) was associated with differences in mortality. Neonates who underwent ECLS for CDH were identified within the Extracorporeal Life Support Organization (ELSO) Registry. Patients were categorized as those on HFOV versus on CMV immediately before initiating ECLS. Patients were matched 1:1 for severity based on pre-ECLS covariates using the propensity score (PS) for ventilator choice. There were 2,892 infants with an overall mortality of 47.3%. Conventional ventilation was used before ECLS in 677 (23.4%) and HFOV in 2,215 (76.6%). Of these, 1,354 infants were matched (1:1) based on ventilator choice (677 CMV and 677 HFOV). High-frequency oscillatory ventilation was associated with 49% higher odds of mortality based on 677 PS matched pairs (odds ratio [OR] = 1.492, 95% confidence interval [CI]: 1.200-1.856, p < 0.001). Patients who received pre-ECLS mechanical ventilation with HFOV were noted to have higher mortality in neonates with CDH compared to CMV.