Ian C Glenn1, Sophia Abdulhai1, Neil L McNinch2, Pamela A Lally3, Todd A Ponsky1, Avraham Schlager4. 1. Department of Surgery, Akron Children's Hospital, 1 Perkins Sq, Ste 8400, Akron, OH, 44308, USA. 2. Akron Children's Hospital, Rebecca D. Considine Research Institute, 130 W. Exchange St, Akron, OH, 44302, USA. 3. Department of Pediatric Surgery and Children's Memorial Hermann Hospital, The University of Texas McGovern Medical School, Suite 5.258, 6431 Fannin Street, Houston, TX, 77030, USA. 4. Department of Surgery, Akron Children's Hospital, 1 Perkins Sq, Ste 8400, Akron, OH, 44308, USA. avi.schlager@gmail.com.
Abstract
PURPOSE: Optimal timing of congenital diaphragmatic hernia (CDH) repair in patients requiring extracorporeal membrane oxygenation (ECMO) remains controversial. The "late ECMO repair" is an approach where the patient, once deemed stable for decannulation, is repaired while still on ECMO to enable expeditious return to ECMO if surgery induces instability. The goal of this study was to investigate the potential benefit of this approach by evaluating the rate of return to ECMO after repair. METHODS: The CDH Study Group database was used to analyze CDH patients requiring ECMO support. The primary outcome was return to ECMO within 72 h of CDH repair among those repaired following ECMO decannulation ("post-ECMO" patients). Secondary outcomes were death within 72 h of repair and cumulative death and return to ECMO rate. RESULTS: A total of 668 patients were repaired post-ECMO decannulation. Six patients (0.9%) in the post-ECMO group required return to ECMO within 72 h of surgery and a total of 19 (2.8%) died or returned to ECMO within 72 h of surgery. CONCLUSION: The rate of return to ECMO and death following CDH repair is extremely low and does not justify the risks inherent to "on-ECMO" repair. Patients stable to come off ECMO should undergo repair after decannulation.
PURPOSE: Optimal timing of congenital diaphragmatic hernia (CDH) repair in patients requiring extracorporeal membrane oxygenation (ECMO) remains controversial. The "late ECMO repair" is an approach where the patient, once deemed stable for decannulation, is repaired while still on ECMO to enable expeditious return to ECMO if surgery induces instability. The goal of this study was to investigate the potential benefit of this approach by evaluating the rate of return to ECMO after repair. METHODS: The CDH Study Group database was used to analyze CDH patients requiring ECMO support. The primary outcome was return to ECMO within 72 h of CDH repair among those repaired following ECMO decannulation ("post-ECMO" patients). Secondary outcomes were death within 72 h of repair and cumulative death and return to ECMO rate. RESULTS: A total of 668 patients were repaired post-ECMO decannulation. Six patients (0.9%) in the post-ECMO group required return to ECMO within 72 h of surgery and a total of 19 (2.8%) died or returned to ECMO within 72 h of surgery. CONCLUSION: The rate of return to ECMO and death following CDH repair is extremely low and does not justify the risks inherent to "on-ECMO" repair. Patients stable to come off ECMO should undergo repair after decannulation.
Entities:
Keywords:
Congenital diaphragmatic hernia; Extracorporeal membrane oxygenation; Thoracic surgery
Authors: Emily A Partridge; William H Peranteau; Natalie E Rintoul; Lisa M Herkert; Alan W Flake; N Scott Adzick; Holly L Hedrick Journal: J Pediatr Surg Date: 2014-11-07 Impact factor: 2.545
Authors: Theresa R Grover; Karna Murthy; Beverly Brozanski; Jason Gien; Natalie Rintoul; Sarah Keene; Tasnim Najaf; Louis Chicoine; Nicolas Porta; Isabella Zaniletti; Eugenia K Pallotto Journal: Am J Perinatol Date: 2015-03-31 Impact factor: 1.862
Authors: Pramod S Puligandla; Julia Grabowski; Mary Austin; Holly Hedrick; Elizabeth Renaud; Meghan Arnold; Regan F Williams; Kathleen Graziano; Roshni Dasgupta; Milissa McKee; Monica E Lopez; Tim Jancelewicz; Adam Goldin; Cynthia D Downard; Saleem Islam Journal: J Pediatr Surg Date: 2015-09-21 Impact factor: 2.545
Authors: David W Kays; James L Talbert; Saleem Islam; Shawn D Larson; Janice A Taylor; Joy Perkins Journal: J Am Coll Surg Date: 2016-01-28 Impact factor: 6.113
Authors: Sara C Fallon; Darrell L Cass; Oluyinka O Olutoye; Irving J Zamora; David A Lazar; Emily L Larimer; Stephen E Welty; Alicia A Moise; Ann B Demny; Timothy C Lee Journal: J Pediatr Surg Date: 2013-06 Impact factor: 2.545
Authors: Maria D Politis; Eva Bermejo-Sánchez; Mark A Canfield; Paolo Contiero; Janet D Cragan; Saeed Dastgiri; Hermien E K de Walle; Marcia L Feldkamp; Amy Nance; Boris Groisman; Miriam Gatt; Adriana Benavides-Lara; Paula Hurtado-Villa; Kärin Kallén; Danielle Landau; Nathalie Lelong; Jorge Lopez-Camelo; Laura Martinez; Margery Morgan; Osvaldo M Mutchinick; Anna Pierini; Anke Rissmann; Antonin Šípek; Elena Szabova; Wladimir Wertelecki; Ignacio Zarante; Marian K Bakker; Vijaya Kancherla; Pierpaolo Mastroiacovo; Wendy N Nembhard Journal: Ann Epidemiol Date: 2020-11-27 Impact factor: 3.797