Congenital diaphragmatic hernia repair in patients on extracorporeal membrane oxygenation: How early can we repair?

J Pediatr Surg. 2019 Jan;54(1):50-54. doi: 10.1016/j.jpedsurg.2018.10.038. Epub 2018 Oct 5.

Abstract

Background: The benefits to early repair (<72 h postcannulation) of infants with congenital diaphragmatic hernia (CDH) on extracorporeal membrane oxygenation (ECMO) are increasingly recognized. Yet it is not known if even earlier repair (<24 h) results in comparable or improved patient outcomes. The goal of this study was to compare "super-early" (<24 h) to early repair (24-72 h) of CDH patients on ECMO.

Methods: A retrospective review of infants with CDH placed on ECMO (2004-2017; n = 72) was performed. Data collected on the patients repaired while on ECMO within 72 h of cannulation (n = 33) included pre- and postnatal disease severity stratification variables and postnatal outcomes. Comparison groups were those patients repaired within 24 h of cannulation (n = 14) and those repaired between 24 and 72 h postcannulation (n = 19).

Results: Patients undergoing "super-early" (<24 h) repair had an average survival of 71.4% compared to the average survival of 59.7% in the early repair group. Pre- and postnatal variables predicting disease severity were not significantly different between the groups. Mean hospital stays, ventilator days, and cannulation days were statistically similar between the groups.

Conclusions: Repair of patients with CDH patients on ECMO at less than 24 h postcannulation achieves outcomes that are comparable to those of repair between 24 and 72 h. While the present data suggest that there is not a "too early" time point for CDH repair on ECMO, larger multicenter studies are needed to validate our findings and determine the overall benefits.

Type of study: Retrospective comparative study.

Level of evidence: Level III.

Keywords: Congenital diaphragmatic hernia (CDH); Extracorporeal membrane oxygenation (ECMO); Outcomes; Prenatal diagnosis; Repair.

Publication types

  • Comparative Study

MeSH terms

  • Extracorporeal Membrane Oxygenation / statistics & numerical data*
  • Female
  • Hernias, Diaphragmatic, Congenital / mortality
  • Hernias, Diaphragmatic, Congenital / surgery*
  • Herniorrhaphy / methods*
  • Humans
  • Infant, Newborn
  • Length of Stay / statistics & numerical data
  • Male
  • Retrospective Studies
  • Severity of Illness Index
  • Survival Rate
  • Time-to-Treatment / statistics & numerical data*