title: Congenital diaphragmatic hernia: to repair on or off extracorporeal membrane oxygenation?
abstract: BACKGROUND
  Congenital diaphragmatic hernia (CDH) can be repaired on or off extracorporeal membrane oxygenation (ECMO). In many centers, operating off ECMO is advocated to prevent bleeding complications. We aimed to compare surgery-related bleeding complications between repair on or off ECMO.
  
  
  METHODS
  All patients with CDH repair and ECMO treatment between January 1, 1995, and May 31, 2008, were retrospectively reviewed. Tranexamic acid was routinely given to all patients repaired on ECMO for 24 hours perioperatively after 2003. Extra-fluid expansion, transfusion, or relaparotomy caused by postoperative bleeding were scored as surgery-related bleeding complications and were related to the Extracorporeal Life Support Organization (ELSO) registry. We used χ(2) test and t test for statistics.
  
  
  RESULTS
  Demographic data and surgery-related bleeding complications in the on-ECMO group were not significantly different compared with the off-ECMO group (P = .331) in our institute. In contrast, more surgery-related bleeding complications were reported by ELSO in their on-ECMO group (P < .0001).
  
  
  CONCLUSIONS
  In contrast to the data from the ELSO registry, we did not observe significantly more surgery-related bleeding complications after CDH repair on ECMO. Using a specific perioperative hemostatic treatment enabled us to perform CDH repair on ECMO with a low frequency of bleeding complications, thereby taking advantage of having the physiologic benefits of ECMO available perioperatively.
authors.affiliation: Department of Pediatric Surgery, Erasmus MC-Sophia, 3015 GJ Rotterdam, the Netherlands.
authors.forename: Richard
authors.initials: R
authors.lastname: Keijzer
authors.forename: Dorien E
authors.initials: DE
authors.lastname: Wilschut
authors.forename: Robert Jan
authors.initials: RJ
authors.lastname: Houmes
authors.forename: Kees P
authors.initials: KP
authors.lastname: van de Ven
authors.forename: Lieke
authors.initials: L
authors.lastname: van den Hout
authors.forename: Ilona
authors.initials: I
authors.lastname: Sluijter
authors.forename: Peter
authors.initials: P
authors.lastname: Rycus
authors.forename: Klaas M
authors.initials: KM
authors.lastname: Bax
authors.forename: Dick
authors.initials: D
authors.lastname: Tibboel
mesh_terms: D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods; D005260:Female; D006548:Hernia, Diaphragmatic / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D012042:Registries; D012189:Retrospective Studies; D014148:Tranexamic Acid / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid