Related Experiment Videos
Congenital diaphragmatic hernia. Outcome of preoperative extracorporeal membrane oxygenation
K Rais-Bahrami1, S T Robbins, V L Reed
1George Washington University School of Medicine, Washington DC, USA.
Insights
Infants with congenital diaphragmatic hernia (CDH) needing extracorporeal membrane oxygenation (ECMO) before surgery face higher morbidity but similar growth outcomes compared to those repaired before ECMO.
Area of Science:
- Pediatric Surgery
- Neonatology
- Critical Care Medicine
Background:
- Congenital diaphragmatic hernia (CDH) management increasingly involves extracorporeal membrane oxygenation (ECMO) for unstable infants.
- Preoperative ECMO is reserved for critically ill neonates unable to tolerate immediate surgical repair.
Purpose of the Study:
- To assess the outcomes and risks for CDH infants requiring ECMO support prior to surgical repair.
- To compare outcomes of pre-ECMO repair versus post-ECMO repair in a cohort of CDH survivors.
Main Methods:
- Retrospective comparison of 11 infants (Group A) on pre-CDH repair ECMO with 22 historical survivors (Group B) repaired before ECMO.
- Analysis of demographic data, hernia characteristics, repair types, ECMO duration, hospitalization length, and post-operative complications.
- Assessment of growth at 1 year of age for both groups.
Main Results:
- Group A had more females, right-sided hernias, and required more patch repairs.
- Group A experienced longer ECMO times, extubation times, and hospitalizations.
- Reherniation rates were higher with patch repairs; reflux and Nissen fundoplication rates were higher in Group A.
Conclusions:
- Infants requiring ECMO before CDH repair are sicker and have increased post-ECMO morbidity.
- Despite higher initial acuity and morbidity, growth failure at 1 year is similar between pre-ECMO and pre-repair groups.
- This suggests ECMO provides a viable bridge to repair for high-risk CDH patients, though careful monitoring for complications is essential.
Abstract:
In recent years, increasing numbers of patients with congenital diaphragmatic hernia (CDH) have been offered extracorporeal membrane oxygenation (ECMO) preoperatively if they can not physiologically tolerate early surgical repair. These infants are sicker are more unstable than those repaired pre-ECMO and, in most cases, have not had a "honeymoon" period (i.e., PaO2>100 mm Hg at some point). ECMO before surgical repair was offered to 27 CDH patients in our institution; of the 16 (59%) survivors, 11 are now 2 years of age to older. To determine the outcome risk for this critical population, we compared 11 infants placed on ECMO pre-CDH repair (Group A) with our previous series of 22 survivors who had their surgery prior to ECMO (Group B). Both groups were similar in birth weight, gestational age, and Apgar scores. In Group A, a greater number were females (73% vs 23%), had right-sided hernia (64% vs 23%), and required patch repairs (82% vs 23%). The mean time on ECMO, time to extubation, and mean length of hospitalization were longer in group A. In both groups combined, the frequency of reherniation was higher in the patch-repair infants compared with those with a primary closure. Incidence of reflux was high in both groups, with increasing frequency of Nissen fundoplication in Group A patients (45% vs 6%). Both groups demonstrated similar delayed growth at 1 year of age. Although infants placed on ECMO presurgery are sicker, with more post-ECMO morbidity, their growth failure is similar to the less sick infants repaired pre-ECMO.(ABSTRACT TRUNCATED AT 250 WORDS)