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Pediatric Surgery International

, Volume 34, Issue 11, pp 1163–1169 | Cite as

Controversies in extracorporeal membrane oxygenation (ECMO) utilization and congenital diaphragmatic hernia (CDH) repair using a Delphi approach: from the American Pediatric Surgical Association Critical Care Committee (APSA-CCC)

  • Sarah B. Cairo
  • Mary Arbuthnot
  • Laura A. Boomer
  • Michael W. Dingeldein
  • Alexander Feliz
  • Samir Gadepalli
  • Chris R. Newton
  • Robert RiccaJr.
  • Adam M. Vogel
  • David H. Rothstein
  • On behalf of the American Pediatric Surgical Association, Surgical Critical Care Committee
Original Article

Abstract

Purpose

Review current practices and expert opinions on contraindications to extracorporeal membrane oxygenation (ECMO) in congenital diaphragmatic hernia (CDH) and contraindications to repair of CDH following initiation of ECMO.

Methods

Modified Delphi method was employed to achieve consensus among members of the American Pediatric Surgical Association Critical Care Committee (APSA-CCC).

Results

Overall response rate was 81% including current and former members of the APSA-CCC. An average of 5–15 CDH repairs were reported annually per institution; 26–50% of patients required ECMO. 100% of respondents would not offer ECMO to a patient with a complex or unrepairable cardiac defects or lethal chromosomal abnormality; 94.1% would not in the setting of severe intracranial hemorrhage (ICH). 76.5% and 72.2% of respondents would not offer CDH repair to patients on ECMO with grade III–IV ICH or new diagnosis of lethal genetic or metabolic abnormalities, respectively. There was significant variability in whether or not to repair CDH if unable to wean from ECMO at 4–5 weeks.

Conclusions

Significant variability in practice pattern and opinions exist regarding contraindications to ECMO and when to offer repair of CDH for patients on ECMO. Ongoing work to evaluate outcomes is needed to standardize management and minimize potentially futile interventions.

Level of evidence

V (expert opinion).

Keywords

Congenital diaphragmatic hernia Extracorporeal membrane oxygenation ECMO CDH Pediatric surgery 

Notes

Funding

This research did not receive any specific Grant from funding agencies in the public, commercial, not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

Dr. Cairo reports that she has no conflict of interest. Dr. Arbuthnot reports that she has no conflicts of interest. Dr. Boomer has no conflicts of interest to report. Dr. Dingeldein has no relevant conflicts of interest to report. Dr. Feliz has no conflicts of interest to report. Dr. Gadepalli reports that he has no conflicts of interest. Dr. Newton reports that he has no conflicts of interest. Dr. Ricca Jr has no conflicts of interest to report. Dr. Vogel reports no conflicts of interest relevant to the present study. Senior author, Dr. Rothstein, reports that he has no conflicts of interest.

Ethical approval

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

Supplementary material

383_2018_4337_MOESM1_ESM.pdf (265 kb)
Supplementary material 1 (PDF 264 KB)
383_2018_4337_MOESM2_ESM.pdf (189 kb)
Supplementary material 2 (PDF 188 KB)
383_2018_4337_MOESM3_ESM.pdf (136 kb)
Supplementary material 3 (PDF 136 KB)
383_2018_4337_MOESM4_ESM.docx (16 kb)
Supplementary material 4 (DOCX 15 KB)

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Copyright information

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

Authors and Affiliations

  • Sarah B. Cairo
    • 1
  • Mary Arbuthnot
    • 2
  • Laura A. Boomer
    • 3
  • Michael W. Dingeldein
    • 4
  • Alexander Feliz
    • 5
  • Samir Gadepalli
    • 6
  • Chris R. Newton
    • 7
  • Robert RiccaJr.
    • 2
  • Adam M. Vogel
    • 8
  • David H. Rothstein
    • 1
    • 9
  • On behalf of the American Pediatric Surgical Association, Surgical Critical Care Committee
  1. 1.Department of Pediatric SurgeryJohn R. Oishei Children’s HospitalBuffaloUSA
  2. 2.Department of Pediatric and General SurgeryNaval Medical Center PortsmouthPortsmouthUSA
  3. 3.Department of SurgeryChildren’s Hospital of Richmond at Virginia Commonwealth UniversityRichmondUSA
  4. 4.Department of Pediatric SurgeryRainbow Babies and Children HospitalClevelandUSA
  5. 5.Department of Pediatric SurgeryUniversity of Tennessee Health SciencesMemphisUSA
  6. 6.C.S. Mott Children’s Hospital, Michigan MedicineAnn ArborUSA
  7. 7.Department of Pediatric SurgeryUniversity of California at San Francisco Benioff Children’s Hospital OaklandSan FranciscoUSA
  8. 8.Department of Pediatric General SurgeryTexas Children’s HospitalHoustonUSA
  9. 9.Department of Surgery, Jacobs School of MedicineState University of New York, University at BuffaloBuffaloUSA

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