Abstract
Introduction
The optimal timing of repair for congenital diaphragmatic hernia (CDH) patients that
require ECMO is controversial. Early repair on ECMO theoretically allows for restoration
of normal thoracic anatomy but entails significant bleeding risks. The purpose of
this study was to examine the institutional outcomes of early CDH repair on ECMO.
Methods
The records of infants with CDH placed on ECMO from 2001 to 2011 were reviewed. Since
2009, a protocol was instituted for early repair while on ECMO. For this study, three
cohorts were analyzed: early repair (<72 h), late repair (>72 h), and post-decannulation. These groups were compared for outcomes regarding morbidity
and survival.
Results
Forty-six CDH patients received ECMO support with an overall survival of 53%. Twenty-nine
patients (11 early/18 late) were repaired on ECMO, while 17 patients had repair post-decannulation.
Survival was 73%, 50%, and 64% for those repaired early, late, or post-decannulation,
respectively. Despite significantly worse prenatal factors, patients repaired early
on ECMO had a similar survival. When comparing patients repaired on ECMO, the early
group patients were decannulated 6 days earlier (p-value = 0.009) and had significantly lower circuit complications (p = 0.03).
Conclusion
In conclusion, early repair on ECMO was associated with decreased ECMO duration, decreased
circuit complications, and a trend towards improved survival.
Key words
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References
- Estimating disease severity of congenital diaphragmatic hernia in the first 5 minutes of life..J Pediatr Surg. 2001; 36: 141-145
- Congenital diaphragmatic hernia. Stabilization and repair on ECMO.Ann Surg. 1992; 216: 569-573
- The role of extracorporeal membrane oxygenation in the management of infants with congenital diaphragmatic hernia.Semin Perinatol. 2005; 29: 118-122
- The role of extracorporeal membrane oxygenation in congenital diaphragmatic hernia.Semin Pediatr Surg. 2005; 14: 72-76
- The impact of extracorporeal membrane support in the treatment of congenital diaphragmatic hernia.J Pediatr Surg. 1991; 26: 791-793
- Extracorporeal membrane oxygenation in infants with congenital diaphragmatic hernia: a systematic review of the evidence.Eur J Pediatr Surg. 2006; 16: 385-391
- Predictors of survival in congenital diaphragmatic hernia patients requiring extracorporeal membrane oxygenation: CNMC 15-year experience.J Perinatol. 2010; 30: 546-552
- Outcome analysis of neonates with congenital diaphragmatic hernia treated with venovenous vs venoarterial extracorporeal membrane oxygenation.J Pediatr Surg. 2009; 44: 1691-1701
- Factors influencing survival in newborns with congenital diaphragmatic hernia: the relative role of timing of surgery.J Pediatr Surg. 2004; 39 ([discussion 821–4]): 821-824
- Delayed repair of congenital diaphragmatic hernia with early high-frequency oscillatory ventilation during preoperative stabilization.J Pediatr Surg. 1998; 33 ([discussion 1014–6]): 1010-1014
- Congenital diaphragmatic hernia requiring extracorporeal membrane oxygenation: does timing of repair matter?.J Pediatr Surg. 2009; 44 ([discussion 1171–2]): 1165-1171
- Venovenous cannulation for extracorporeal membrane oxygenation using a bicaval dual-lumen catheter in neonates.J Pediatr Surg. 2012; 47: 430-434
- Predictors of outcome in patients with congenital diaphragmatic hernia requiring extracorporeal membrane oxygenation.J Pediatr Surg. 2007; 42: 1345-1350
- Early repair of congenital diaphragmatic hernia on extracorporeal membrane oxygenation.J Pediatr Surg. 2010; 45: 693-697
- Hemorrhagic complications and repair of congenital diaphragmatic hernias: does timing of the repair make a difference? Data from the Extracorporeal Life Support Organization.J Pediatr Surg. 1994; 29 ([discussion 1005–6]): 1002-1005
- Evaluation of heparin assay for coagulation management in newborns undergoing ECMO.Am J Clin Pathol. 2010; 134: 950-954
- Anticoagulation and pediatric extracorporeal membrane oxygenation: impact of activated clotting time and heparin dose on survival.Ann Thorac Surg. 2007; 83 ([discussion 919–20]): 912-919
- Congenital diaphragmatic hernia: to repair on or off extracorporeal membrane oxygenation?.J Pediatr Surg. 2012; 47: 631-636
- Impact of AMICAR on hemorrhagic complications of ECMO: a ten-year review.J Pediatr Surg. 2003; 38: 1212-1216
- Long-term outcome following extracorporeal membrane oxygenation for congenital diaphragmatic hernia: the UK experience.J Pediatr. 2004; 144: 309-315
Article info
Publication history
Accepted:
March 8,
2013
Received:
February 21,
2013
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
