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01-07-2018 | Original Article

Evaluating the utility of the “late ECMO repair”: a congenital diaphragmatic hernia study group investigation

Authors: Ian C. Glenn, Sophia Abdulhai, Neil L. McNinch, Pamela A. Lally, Todd A. Ponsky, Avraham Schlager, For the Congenital Diaphragmatic Hernia Study Group

Published in: Pediatric Surgery International | Issue 7/2018

Abstract

Purpose

Optimal timing of congenital diaphragmatic hernia (CDH) repair in patients requiring extracorporeal membrane oxygenation (ECMO) remains controversial. The “late ECMO repair” is an approach where the patient, once deemed stable for decannulation, is repaired while still on ECMO to enable expeditious return to ECMO if surgery induces instability. The goal of this study was to investigate the potential benefit of this approach by evaluating the rate of return to ECMO after repair.

Methods

The CDH Study Group database was used to analyze CDH patients requiring ECMO support. The primary outcome was return to ECMO within 72 h of CDH repair among those repaired following ECMO decannulation (“post-ECMO” patients). Secondary outcomes were death within 72 h of repair and cumulative death and return to ECMO rate.

Results

A total of 668 patients were repaired post-ECMO decannulation. Six patients (0.9%) in the post-ECMO group required return to ECMO within 72 h of surgery and a total of 19 (2.8%) died or returned to ECMO within 72 h of surgery.

Conclusion

The rate of return to ECMO and death following CDH repair is extremely low and does not justify the risks inherent to “on-ECMO” repair. Patients stable to come off ECMO should undergo repair after decannulation.

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Title: Evaluating the utility of the “late ECMO repair”: a congenital diaphragmatic hernia study group investigation
Authors: Ian C. Glenn
Sophia Abdulhai
Neil L. McNinch
Pamela A. Lally
Todd A. Ponsky
Avraham Schlager
For the Congenital Diaphragmatic Hernia Study Group
Publication date: 01-07-2018
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Surgery International / Issue 7/2018
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-018-4283-8

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Springer Medicine

Evaluating the utility of the “late ECMO repair”: a congenital diaphragmatic hernia study group investigation

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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