title: Repair of congenital diaphragmatic hernias on Extracorporeal Membrane Oxygenation (ECMO): does early repair improve patient survival?
abstract: BACKGROUND
  The optimal timing of repair for congenital diaphragmatic hernia (CDH) patients that require ECMO is controversial. Early repair on ECMO theoretically allows for restoration of normal thoracic anatomy but entails significant bleeding risks. The purpose of this study was to examine the institutional outcomes of early CDH repair on ECMO.
  
  
  METHODS
  The records of infants with CDH placed on ECMO from 2001 to 2011 were reviewed. Since 2009, a protocol was instituted for early repair while on ECMO. For this study, three cohorts were analyzed: early repair (<72 h), late repair (>72 h), and post-decannulation. These groups were compared for outcomes regarding morbidity and survival.
  
  
  RESULTS
  Forty-six CDH patients received ECMO support with an overall survival of 53%. Twenty-nine patients (11 early/18 late) were repaired on ECMO, while 17 patients had repair post-decannulation. Survival was 73%, 50%, and 64% for those repaired early, late, or post-decannulation, respectively. Despite significantly worse prenatal factors, patients repaired early on ECMO had a similar survival. When comparing patients repaired on ECMO, the early group patients were decannulated 6 days earlier (p-value=0.009) and had significantly lower circuit complications (p=0.03).
  
  
  CONCLUSIONS
  In conclusion, early repair on ECMO was associated with decreased ECMO duration, decreased circuit complications, and a trend towards improved survival.
authors.affiliation: Texas Children's Fetal Center, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
authors.forename: Sara C
authors.initials: SC
authors.lastname: Fallon
authors.forename: Darrell L
authors.initials: DL
authors.lastname: Cass
authors.forename: Oluyinka O
authors.initials: OO
authors.lastname: Olutoye
authors.forename: Irving J
authors.initials: IJ
authors.lastname: Zamora
authors.forename: David A
authors.initials: DA
authors.lastname: Lazar
authors.forename: Emily L
authors.initials: EL
authors.lastname: Larimer
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Welty
authors.forename: Alicia A
authors.initials: AA
authors.lastname: Moise
authors.forename: Ann B
authors.initials: AB
authors.lastname: Demny
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Lee
mesh_terms: D015331:Cohort Studies; D003131:Combined Modality Therapy; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006548:Hernia, Diaphragmatic / Q000401:mortality / Q000601:surgery / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
keywords: CDH; ECMO; Pediatrics