Early CDH repair on ECMO: Improved survival but no decrease in ECMO duration (A CDH Study Group Investigation).

Abstract:

PURPOSE:"Early on-ECMO" repair of CDH entails repair within 48-72 h of cannulation in an effort to optimize pulmonary physiology, shorten ECMO duration, and, ultimately, improve survival. This study evaluated the effect of early on-ECMO repair as compared to leaving patients unrepaired during ECMO. METHODS:The CDH Study Group database was queried for CDH patients requiring ECMO who either underwent repair within the first 72 h after cannulation or remained unrepaired on ECMO. Primary outcomes were survival to decannulation and ECMO duration. RESULTS:A total of 248 patients underwent early repair and 922 remained unrepaired on ECMO. The early repair group had increased risk factors for poor outcomes, including higher odds of cardiac defects and thoracic liver location, and lower odds of hernia sac presence. Nonetheless, ECMO survival for the early repair group was 87.1% compared to 78.4% in the unrepaired group (p = 0.002). However, the early repair group had a longer median ECMO duration than the unrepaired group (240.6 vs 196.8 h, p = 0.001). CONCLUSION:While early ECMO repair does not shorten ECMO duration, it results in increased survival to decannulation as compared to those unrepaired on ECMO. This suggests that there may be a physiologic benefit leading to increased ECMO survival in a subset of patients undergoing on-ECMO repair over those designated to undergo post-ECMO repair. LEVEL OF EVIDENCE:Level III.

journal_name

J Pediatr Surg

authors

Glenn IC,Abdulhai S,Lally PA,Schlager A,Congenital Diaphragmatic Hernia Study Group.

doi

10.1016/j.jpedsurg.2019.01.063

subject

Has Abstract

pub_date

2019-10-01 00:00:00

pages

2038-2043

issue

10

eissn

0022-3468

issn

1531-5037

pii

S0022-3468(19)30119-8

journal_volume

54

pub_type

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