Emily H Steen1, Timothy C Lee2, Adam M Vogel2, Sara C Fallon2, Caraciolo J Fernandes3, Candace C Style4, Mariatu A Verla1, Swathi Balaji2, Oluyinka O Olutoye2, Sundeep G Keswani5. 1. Baylor College of Medicine, Michael E. DeBakey Department of Surgery, Houston, TX, USA. 2. Baylor College of Medicine, Michael E. DeBakey Department of Surgery, Houston, TX, USA; Texas Children's Hospital, Department of Pediatric Surgery, Houston, TX, USA. 3. Texas Children's Hospital, Department of Pediatrics, Division of Neonatology, Houston, TX, USA. 4. Texas Children's Hospital, Department of Pediatric Surgery, Houston, TX, USA. 5. Baylor College of Medicine, Michael E. DeBakey Department of Surgery, Houston, TX, USA; Texas Children's Hospital, Department of Pediatric Surgery, Houston, TX, USA. Electronic address: keswani@bcm.edu.
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.
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.