title: Congenital diaphragmatic hernia requiring extracorporeal membrane oxygenation: does timing of repair matter?
abstract: OBJECTIVE
  Severe congenital diaphragmatic hernia (CDH) requiring extracorporeal membrane oxygenation (ECMO) is associated with high mortality. Timing of CDH repair relative to ECMO therapy remains controversial. Our hypothesis was that survival would significantly differ between those who underwent repair during ECMO and those who underwent repair after ECMO therapy.
  
  
  METHODS
  We examined deidentified data from the CDH study group (CDHSG) registry from 1995 to 2005 on patients who underwent repair and ECMO therapy (n = 636). We used Cox regression analysis to assess differences in survival between those who underwent repair during and after ECMO.
  
  
  RESULTS
  Five covariates were significantly associated with mortality as follows: timing of repair relative to ECMO (P = .03), defect side (P = .01), ECMO run length (P < .01), need for patch repair (P = .03), birth weight (P < .01), and Apgar score at 5 minutes (P = .03). Birth year, inborn vs transfer status, diaphragmatic agenesis, age at repair, and presence of cardiac or chromosomal abnormalities were not associated with survival. Repair after ECMO therapy was associated with increased survival relative to repair on ECMO (hazard ratio, 1.407; P = .03).
  
  
  CONCLUSIONS
  These data suggest that CDH repair after ECMO therapy is associated with improved survival compared to repair on ECMO, despite controlling for factors associated with the severity of CDH.
authors.affiliation: University of Michigan Medical School, Ann Arbor, MI 48109, USA.
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Bryner
authors.forename: Brady T
authors.initials: BT
authors.lastname: West
authors.forename: Ronald B
authors.initials: RB
authors.lastname: Hirschl
authors.forename: Robert A
authors.initials: RA
authors.lastname: Drongowski
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Lally
authors.forename: Pamela
authors.initials: P
authors.lastname: Lally
authors.forename: George B
authors.initials: GB
authors.lastname: Mychaliska
mesh_terms: D003964:Diaphragm / Q000601:surgery; D015199:Extracorporeal Membrane Oxygenation / Q000401:mortality; D006548:Hernia, Diaphragmatic / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D016016:Proportional Hazards Models; D012042:Registries; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome