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Pediatric Surgery International

, Volume 34, Issue 7, pp 721–726 | Cite as

Evaluating the utility of the “late ECMO repair”: a congenital diaphragmatic hernia study group investigation

  • Ian C. Glenn
  • Sophia Abdulhai
  • Neil L. McNinch
  • Pamela A. Lally
  • Todd A. Ponsky
  • Avraham Schlager
  • For the Congenital Diaphragmatic Hernia Study Group
Original Article

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.

Keywords

Congenital diaphragmatic hernia Extracorporeal membrane oxygenation Thoracic surgery 

Abbreviations

CDH

Congenital diaphragmatic hernia

ECMO

Extracorporeal membrane oxygenation

Notes

Funding

This study has no funding sources.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required.

Supplementary material

383_2018_4283_MOESM1_ESM.xlsx (13 kb)
A list of institutions that contributed to the Congenital Diaphragmatic Hernia Study Group database (XLSX 13 KB)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Ian C. Glenn
    • 1
  • Sophia Abdulhai
    • 1
  • Neil L. McNinch
    • 2
  • Pamela A. Lally
    • 3
  • Todd A. Ponsky
    • 1
  • Avraham Schlager
    • 1
  • For the Congenital Diaphragmatic Hernia Study Group
  1. 1.Department of SurgeryAkron Children’s HospitalAkronUSA
  2. 2.Akron Children’s HospitalRebecca D. Considine Research InstituteAkronUSA
  3. 3.Department of Pediatric Surgery and Children’s Memorial Hermann HospitalThe University of Texas McGovern Medical SchoolHoustonUSA

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