Early repair of congenital diaphragmatic hernia on extracorporeal membrane oxygenation.
BACKGROUND
Timing of repair of congenital diaphragmatic hernia (CDH) in babies that require stabilization on extracorporeal membrane oxygenation (ECMO) remains controversial. Although many centers delay operation until physiologic stabilization has occurred or ECMO is no longer needed, we repair soon after ECMO has been initiated. The purpose of this study is to determine if our approach has achieved acceptable morbidity and mortality.


METHODS
Charts of live-born babies with CDH treated at our institution between 1993 and 2007 were retrospectively reviewed. Data were then compared with The Congenital Diaphragmatic Hernia Study Group and Extracorporeal Life Support Organization registries.


RESULTS
Forty-eight (39%) patients required ECMO Thirty-four of these 48 neonates were cannulated before operative repair. Venoarterial ECMO was used exclusively. The mean (SD) time of repair from cannulation was 55 (21) hours. Survival for this subset of patients was 71%. Three patients (8.8%) who underwent repair on ECMO experienced surgical site hemorrhage that required intervention.


CONCLUSIONS
Early repair of CDH in neonates on ECMO can be accomplished with acceptable rates of morbidity and mortality.
Dassinger
Melvin S
MS
Pediatric Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA. dassingermelvins@uams.edu
Copeland
Daniel R
DR
Gossett
Jeff
J
Little
Danny C
DC
Jackson
Richard J
RJ
Smith
Samuel D
SD
D001131:Arkansas; D015199:Extracorporeal Membrane Oxygenation; D006548:Hernia, Diaphragmatic / Q000601:surgery* / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome