Early CDH repair on ECMO: Improved survival but no decrease in ECMO duration (A CDH Study Group Investigation)

Glenn, Ian C.; Abdulhai, Sophia; Lally, Pamela A.; Schlager, Avraham

doi:10.1016/j.jpedsurg.2019.01.063

Cited by 23 publications

(11 citation statements)

References 15 publications

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“…Data from a large multicenter database suggested that a longer duration of ECMO support after pediatric cardiac surgery was associated with poor outcomes ( 23 ). Glenn et al ( 24 ) found an improved survival rate but no decrease in ECMO duration ( 25 ). In our meta-analysis, we also found no shortening of ECMO or ICU duration between these two groups, with low heterogeneity among the included studies.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Efficacy of ECMO With or Without IABP in Patients With Cardiogenic Shock: A Meta-Analysis

Zeng

Yang

Chen

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveStudies on extracorporeal membrane oxygenation (ECMO) with and without an intra-aortic balloon pump (IABP) for cardiogenic shock (CS) have been published, but there have been no meta-analyses that compare the efficacy of these two cardiac support methods. This meta-analysis evaluated the outcomes of these two different treatment measures.MethodsThe PubMed, Embase, Cochrane Library, Web of Science, and Clinical Trials databases were searched until March 2022. Studies that were related to ECMO with or without IABP in patients with CS were screened. Quality assessments were evaluated with the methodological index for nonrandomized studies (MINORS). The primary outcome was in-hospital survival, while the secondary outcomes included duration of ECMO, duration of ICU stay, infection/sepsis, and bleeding. Revman 5.3 and STATA software were used for this meta-analysis.ResultsIn total, nine manuscripts with 2,573 patients were included in the systematic review. CS patients who received ECMO in combination with IABP had significantly improved in-hospital survival compared with ECMO alone (OR = 1.58, 95% CI = 1.26–1.98, P < 0.0001). However, there were no significant differences in the duration of ECMO (MD = 0.36, 95% CI = −0.12–0.84, P = 0.14), duration of ICU stay (MD = −1.95, 95% CI = −4.05–0.15, P = 0.07), incidence of infection/sepsis (OR = 1.0, 95% CI = 0.58–1.72, P = 1.0), or bleeding (OR = 1.28, 95% CI = 0.48–3.45, P = 0.62) between the two groups of patients with CS.ConclusionECMO combined with IABP can improve in-hospital survival more effectively than ECMO alone in patients with CS.

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Section: Discussionmentioning

confidence: 99%

Comparison of the Efficacy of ECMO With or Without IABP in Patients With Cardiogenic Shock: A Meta-Analysis

Zeng

Yang

Chen

et al. 2022

Front. Cardiovasc. Med.

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“…38 However, no conclusive statements can be made for the role of MIS in children with CDH requiring ECMO, as data in this patient cohort are scarce. 39,40 Hypercapnia and Acidosis during Thoracoscopy One of the most startling studies on MIS repair in CDH was a randomized control trial reporting a significant increase of intraoperative hypercapnia and acidosis. 7 As a consequence, the safety of MIS for CDH repair was questioned.…”

Section: Thoracoscopic Repair and Ecmomentioning

confidence: 99%

Thoracoscopic Repair of Congenital Diaphragmatic Hernia

Wagner

Mayer

et al. 2020

Eur J Pediatr Surg

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The surgical management of patients with congenital diaphragmatic hernia (CDH) is challenging and ever changing. It requires the highest expertise not only on the surgical level but also of neonatologists and anesthesiologists. In selected patients traditional open surgery is increasingly replaced by thoracoscopic CDH repair in many centers worldwide. Despite obvious and well-described advantages of the minimally invasive approach like a shorter ventilatory time, less pain, a shorter hospital length of stay, and a better cosmesis, important controversies remain. This review discusses hot topics of minimally invasive CDH repair, such as extracorporeal membrane oxygenation, hypercapnia/acidosis, patch repair, surgical training, and recurrence.

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“…Apesar de nos últimos anos ter-se assistido a alguma evolução na correção pós-descanulação, ainda poucos centros no mundo realizam esta técnica. [14][15][16] Na nossa amostra apenas um RN realizou correção cirúrgica após ciclo de ECMO e apesar do bom resultado neste caso, não foi possível retirar conclusões sobre a influência do timing de correção cirúrgica na taxa de sobrevivência.…”

Section: Tempo De Correção Cirúrgicaunclassified

ECMO em Recém-nascidos com Hérnia Diafragmática Congénita: A Experiência de um Centro de Referência de ECMO em Portugal

Miranda¹,

Abecasis²,

Almeida³

et al. 2020

Acta Med Port

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Introduction: The use of extracorporeal membrane oxygenation (ECMO) is considered by many authors as one of the most important technological advances in the care of newborns with congenital diaphragmatic hernia. The main objective of this study was to report the experience of a Portuguese ECMO center in the treatment of congenital diaphragmatic hernia.Material and Methods: Descriptive retrospective study of newborns with congenital diaphragmatic hernia requiring ECMO support in a Pediatric Intensive Care Unit from January 2012 to December 2019. Data collection using the Extracorporeal Life Support Organization registration and unit data base.Results: Fourteen newborns were included, all with left congenital diaphragmatic hernia, in a total of 15 venoarterial ECMO cycles. The median gestational age was 38 weeks and the median birth weight was 2.950 kg. Surgical repair was performed before entry into ECMO in six, during in seven and after in one newborn. The average age at placement was 3.3 days and the median cycle duration was 16 days. Prior to ECMO, all newborns had severe hypoxemia and acidosis despite optimized ventilatory support, with nitric oxide and inotropic therapy. After 24 hours on ECMO, there was correction of acidosis, improvement of oxygenation and hemodynamic stability. All cycles presented mechanical complications, the most frequent being the presence of clots in the circuit. The most frequent physiological complications were hemorrhagic and embolic (three newborns suffered an ischemic stroke during the cycle). Five newborns (35.7%) died, all associated with complications (two strokes, two massive bleedings and one accidental decannulation). Chronic lung disease, poor weight gain and psychomotor developmental delay were the most frequent long-term morbidities.Discussion: Despite technological advances in respiratory care and improved safety of the ECMO technique, the management of these newborns is complex and there are still several open questions, including the appropriate selection of patients, the best approach and time for surgical correction, and the treatment of pulmonary hypertension in the presence of persistent fetal shunts.Conclusion: Survival rate was higher than reported in 2017 Extracorporeal Life Support Organization report (64% versus 50%). Mechanical and hemorrhagic complications were very frequent.

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Early CDH repair on ECMO: Improved survival but no decrease in ECMO duration (A CDH Study Group Investigation)

Cited by 23 publications

References 15 publications

Comparison of the Efficacy of ECMO With or Without IABP in Patients With Cardiogenic Shock: A Meta-Analysis

Comparison of the Efficacy of ECMO With or Without IABP in Patients With Cardiogenic Shock: A Meta-Analysis

Thoracoscopic Repair of Congenital Diaphragmatic Hernia

ECMO em Recém-nascidos com Hérnia Diafragmática Congénita: A Experiência de um Centro de Referência de ECMO em Portugal

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