title: Outcomes of congenital diaphragmatic hernia repair on extracorporeal life support.
abstract: OBJECTIVE
  Extracorporeal life support (ECLS) is applied to refractory pulmonary hypertension in congenital diaphragmatic hernia (CDH). We evaluate the single-center outcomes of infants with CDH to determine the utility of late repair on ECLS versus repair post-decannulation.
  
  
  METHODS
  Records of infants with CDH (2004-2014) were retrospectively reviewed.
  
  
  RESULTS
  CDH was diagnosed in 177 infants. Sixty six (37%) underwent ECLS, of which, 11 died prior to repair, 33 were repaired post-decannulation, and 22 were repaired on ECLS. Repair was delayed in patients on ECLS (19 versus 10 days, p < 0.001). Patients repaired on ECLS had longer ECLS runs (22 versus 12 days, p < 0.001) and higher rates of bleeding and mortality than those repaired post-decannulation. Survival was 54% in infants undergoing ECLS, 65% in those who underwent repair, 36% in those repaired during ECLS, and 85% in those who were decannulated prior to repair. Eighteen percent (N = 4) of deaths after repair on ECLS were attributable to surgical bleeding. The remainder was due to pulmonary hypertension or sepsis.
  
  
  CONCLUSIONS
  Infants who underwent CDH repair post-decannulation had excellent outcomes and no mortalities attributable to repair. Neonates who underwent repair on ECLS late on bypass had the lowest survival rate with only 18% of mortality in this cohort attributable to surgical bleeding.
authors.affiliation: Division of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mailstop 100, Los Angeles, CA, 90027, USA.
authors.forename: Jamie
authors.initials: J
authors.lastname: Golden
authors.affiliation: Division of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mailstop 100, Los Angeles, CA, 90027, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Jones
authors.affiliation: Division of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mailstop 100, Los Angeles, CA, 90027, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Zagory
authors.affiliation: Division of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mailstop 100, Los Angeles, CA, 90027, USA.
authors.forename: Shannon
authors.initials: S
authors.lastname: Castle
authors.affiliation: Division of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mailstop 100, Los Angeles, CA, 90027, USA. dbliss@chla.usc.edu.
authors.forename: David
authors.initials: D
authors.lastname: Bliss
mesh_terms: D016063:Blood Loss, Surgical; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D065630:Hernias, Diaphragmatic, Congenital / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008020:Life Support Care / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Congenital diaphragmatic hernia; Extracorporeal life support; Post-operative bleeding; Pulmonary hypertension