SURGERY 305 MULTIPLE STUDIES AT ISOLATED institutions have sug- gested that the mortality for patients with congen- ital diaphragmatic hernia (CDH), even in the modern era, is approximately 50%. 1-4 New inter- ventions such as extracorporeal life support (ECLS) and novel management strategies such as delayed operation and use of lower levels of venti- lator pressure and fraction of inspired oxygen may have had an impact on the mortality of patients with CDH. 5-7 Although the Extracorporeal Life Support Organization (ELSO) registry allows evalu- ation of the survival associated with those newborns with diaphragmatic hernia who require extracor- poreal support, the current overall survival of a national sample of patients with CDH has not pre- viously been determined. Therefore we asked 16 centers who use ECLS and other new management techniques to provide patient-specific data on the patients with diaphragmatic hernia who had been managed during a 2-year period, with the intent of determining the rate of survival of newborn patients with CDH at such centers in the current era. In addition, we examined the data to deter- mine whether the outcome of such patients was related to the yearly case volume at those individual centers. METHODS Sixteen centers with level III neonatal intensive Congenital diaphragmatic hernia survival and use of extracorporeal life support at selected level III nurseries with multimodality support Craig A. Reickert, MD, Ronald B. Hirschl, MD, James B. Atkinson, MD, Golde Dudell, MD, Keith Georgeson, MD, Phil Glick, MD, Jay Greenspan, MD, David Kays, MD, Michael Klein, MD, Kevin P. Lally, MD, Sam Mahaffey, MD, Fred Ryckman, MD, Robert Sawin, MD, Billy L. Short, MD, Charles J. Stolar, MD, Anne Thompson, MD, and Jay M. Wilson, MD, Ann Arbor and Detroit, Mich. Background. Congenital diaphragmatic hernia (CDH) has been cited to have a mortality rate of 50% . There have been multiple studies at individual institutions demonstrating potential benefits from vari- ous strategies including extracorporeal life support (ECLS), delayed repair, and lower levels of ventilator support. There has been no multicenter survey of institutions offering these modalities to describe the cur- rent use of ECLS and survival of these infants. In addition, the relationship between the number of patients with CDH managed at an individual institution and outcome has not been evaluated. Methods. We queried 16 level III neonatal intensive care centers on the use of ECLS and survival of infants with CDH who were treated during 2 consecutive years (1993 to 1995). Data are presented as mean ±SEM, median, and range. Results. Data were collected on 411 patients. Of these, 71% ± 8% were outborn and 8% ± 3% were considered nonviable. Overall survival of CDH infants was 69% ±4% (range, 39% to 95% ). The survival rate of infants on ECLS was 55% ±4% , whereas survival of infants not requiring ECLS was significantly increased at 81% ±5% (p = 0.005). The mean rate of ECLS use was 46% ±2% . There was no correlation between the number of cases per year at an individual institution and overall sur- vival, ECLS survival, or ECLS use (r = 0.341, 0.305, and 0.287, respectively). There was also no corre- lation between case volume at an individual institution and ECLS survival (r = 0.271). Conclusions. The current survival rate and rate of ECLS use in infants with CDH at level III neonatal intensive care units in the United States are 69% ± 4% and 46% ± 2% , respectively. There is no cor- relation between the yearly individual center experience with managing CDH and rate of ECLS use or outcome. (Surgery 1998;123:305-10.) From the University of Michigan Medical Center, Ann Arbor, and Henry Ford Hospital, Detroit, Mich. Accepted for publication Aug. 14, 1997. Reprint requests: Ronald B. Hirschl, MD, F3970 Mott Children’s Hospital, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-0245. Copyright © 1998 by Mosby, Inc. 0039-6060/ 98/ $5.00 + 0 11/ 56/ 86777