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

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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.

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Abbreviations

CDH:

Congenital diaphragmatic hernia

ECMO:

Extracorporeal membrane oxygenation

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Funding

This study has no funding sources.

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Authors and Affiliations

  1. Department of Surgery, Akron Children’s Hospital, 1 Perkins Sq, Ste 8400, Akron, OH, 44308, USA

    Ian C. Glenn, Sophia Abdulhai, Todd A. Ponsky & Avraham Schlager

  2. Akron Children’s Hospital, Rebecca D. Considine Research Institute, 130 W. Exchange St, Akron, OH, 44302, USA

    Neil L. McNinch

  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

    Pamela A. Lally

Authors
  1. Ian C. Glenn
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  2. Sophia Abdulhai
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  3. Neil L. McNinch
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  4. Pamela A. Lally
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  5. Todd A. Ponsky
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  6. Avraham Schlager
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Consortia

For the Congenital Diaphragmatic Hernia Study Group

Corresponding author

Correspondence to Avraham Schlager.

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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.

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

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Glenn, I.C., Abdulhai, S., McNinch, N.L. et al. Evaluating the utility of the “late ECMO repair”: a congenital diaphragmatic hernia study group investigation. Pediatr Surg Int 34, 721–726 (2018). https://doi.org/10.1007/s00383-018-4283-8

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  • DOI: https://doi.org/10.1007/s00383-018-4283-8

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