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Published on: August 15, 2022

Decreasing the Post Surgical Ooze: Utilizing a Perioperative Guideline to Decrease Transfusion Needs Following

Kathleen Heller1, Meriam J Avades2, Navin Bhopal2

  • 1Division of Pediatric Surgery, Phoenix Children's-Phoenix, Arizona.

Journal of Pediatric Surgery
|August 21, 2026
PubMed

Insights

A new guideline for congenital diaphragmatic hernia (CDH) repair on extracorporeal membrane oxygenation (ECMO) reduced post-operative transfusions. This improved survival rates for high-risk infants undergoing this complex procedure.

Area of Science:

  • Pediatric Surgery
  • Neonatal Intensive Care
  • Critical Care Medicine

Background:

  • Congenital diaphragmatic hernia (CDH) repair on extracorporeal membrane oxygenation (ECMO) is a high-risk procedure with significant transfusion requirements.
  • Standardized perioperative management may optimize outcomes for these critically ill infants.

Purpose of the Study:

  • To evaluate the impact of a newly implemented perioperative guideline on post-operative transfusion needs in infants undergoing CDH repair on ECMO.
  • To assess changes in transfusion requirements and patient outcomes following guideline implementation.

Main Methods:

  • A retrospective cohort study compared outcomes of CDH repair on ECMO before and after the 2021 implementation of a perioperative guideline.
  • The guideline included recommendations for pre-operative labs, antifibrinolytics, transfusions, and anticoagulation.
  • Descriptive statistics were used to analyze data from 27 infants (16 Pre-Guideline, 11 Post-Guideline).

Main Results:

  • Infants in the Post-Guideline group received significantly fewer packed red blood cell (pRBC) and platelet transfusions at 24 hours post-operatively.
  • While re-operation for re-bleeding and intraventricular hemorrhage rates showed a trend towards reduction, they were not statistically significant.
  • Survival to hospital discharge significantly improved in the Post-Guideline group (55%) compared to the Pre-Guideline group (13%).

Conclusions:

  • Implementation of a perioperative guideline for CDH repair on ECMO is associated with reduced transfusion requirements.
  • The guideline appears to improve survival outcomes for infants undergoing this complex and high-risk surgical procedure.
Abstract

Keywords:
congenital diaphragmatic herniapediatric extracorporeal life supportstandardized perioperative care

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