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

Link: https://www.ncbi.nlm.nih.gov/pubmed/30482539

J Pediatr Surg. 2018 Oct 5. pii: S0022-3468(130656-0. doi: 10.1016/j.jpedsurg.2018.10.038. [Epub ahead of print]
Congenital diaphragmatic hernia repair in patients on extracorporeal membrane oxygenation: How early can we repair?
Steen EH1, Lee TC2, Vogel AM2, Fallon SC2, Fernandes CJ3, Style CC4, Verla MA1, Balaji S2, Olutoye OO2, Keswani SG5.
Author information
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.

Copyright © 2018 Elsevier Inc. All rights reserved.

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

PMID: 30482539 DOI: 10.1016/j.jpedsurg.2018.10.038