Timing of repair of congenital diaphragmatic hernia in patients supported by extracorporeal membrane oxygenation (ECMO)

Partridge, Emily A.; Peranteau, William H.; Rintoul, Natalie E.; Herkert, Lisa M.; Flake, Alan W.; Adzick, N. Scott; Hedrick, Holly L.

doi:10.1016/j.jpedsurg.2014.11.013

Cited by 66 publications

(30 citation statements)

References 10 publications

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“…Controversies about the exact timing of the surgical repair in patients on ECMO remain [53]. A recent study from Partridge et al [54 ]showed improved outcomes with surgical repair after ECMO, i.e. a higher likelihood of survival, less surgical bleeding and shorter duration of ECMO.…”

Section: Resultsmentioning

confidence: 99%

Standardized Postnatal Management of Infants with Congenital Diaphragmatic Hernia in Europe: The CDH EURO Consortium Consensus - 2015 Update

et al. 2016

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In 2010, the congenital diaphragmatic hernia (CDH) EURO Consortium published a standardized neonatal treatment protocol. Five years later, the number of participating centers has been raised from 13 to 22. In this article the relevant literature is updated, and consensus has been reached between the members of the CDH EURO Consortium. Key updated recommendations are: (1) planned delivery after a gestational age of 39 weeks in a high-volume tertiary center; (2) neuromuscular blocking agents to be avoided during initial treatment in the delivery room; (3) adapt treatment to reach a preductal saturation of between 80 and 95% and postductal saturation >70%; (4) target PaCO₂ to be between 50 and 70 mm Hg; (5) conventional mechanical ventilation to be the optimal initial ventilation strategy, and (6) intravenous sildenafil to be considered in CDH patients with severe pulmonary hypertension. This article represents the current opinion of all consortium members in Europe for the optimal neonatal treatment of CDH.

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Section: Resultsmentioning

confidence: 99%

Standardized Postnatal Management of Infants with Congenital Diaphragmatic Hernia in Europe: The CDH EURO Consortium Consensus - 2015 Update

et al. 2016

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“…Surgical repair while on ECMO is associated with a higher incidence of bleeding. One study, while not dissuading repair on ECMO, identified an increased survival rate if repair could be delayed until off ECMO 42. Therefore, repair has traditionally been performed after decannulation from ECMO.…”

Section: Timing Of Surgery On Ecmomentioning

confidence: 99%

Role of ECMO in congenital diaphragmatic hernia

McHoney

Hammond

2017

Arch Dis Child Fetal Neonatal Ed

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Congenital diaphragmatic hernia (CDH) is typified morphologically by failure of diaphragmatic development with accompanying lung hypoplasia and persistent pulmonary hypertension of the newborn (PPHN). Patients who have labile physiology and low preductal saturations despite optimal ventilatory and inotropic support may be considered for extracorporeal membrane oxygenation (ECMO). Systematic reviews into the benefits of ECMO in CDH concluded that any benefit is unclear. Few randomised trials exist to demonstrate clear benefit and guide management. However, ECMO may have its uses in those that have reversibility of their respiratory disease. A few centres and networks have demonstrated an increase in survival rate by post hoc analysis (based on a difference in referral patterns with the availability of ECMO) in their series. One issue may be that of careful patient selection with regard to reversibility of pathophysiology. At present, there is no single test or prognostication that predicts reversibility of PPHN and criteria for referral for ECMO is undergoing continued refinement. Overall survival is similar between cannulation modes. There is no consensus on the time limit for ECMO runs. The optimal timing of surgery for patients on ECMO is difficult to definitively establish, but it seems that repair at an early stage (with careful perioperative management) is becoming less of a taboo, and may improve outcome and help with either coming off ECMO or decisions on withdrawal later. The provision of ECMO will continue to be evaluated, and prospective randomised trial are needed to help answer question of patient selection and management.

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“…Another recent study also confirmed similar findings, where increased bleeding complications were not observed. 6 Conclusion CDH repair during ECMO is feasible and safe. The role of ECMO has evolved from perioperative stabilization to become a bridging therapy for surgery in CDH patients who do not respond to any other treatment.…”

Section: Discussionmentioning

confidence: 96%

“…In our patient, heparin was given prior to surgery, with the ACT level titrated to 140–160 s. The operation was performed uneventfully without any significant bleeding or thrombotic complications. Another recent study also confirmed similar findings, where increased bleeding complications were not observed …”

Section: Discussionmentioning

confidence: 99%

Use of extracorporeal membrane oxygenation support for congenital diaphragmatic hernia repair: Bridging therapy for successful outcomes

et al. 2017

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Congenital diaphragmatic hernia (CDH) is a rare congenital disease with harmful potential. Mortality is often related to underlying pulmonary hypoplasia and pulmonary hypertension. Extracorporeal membrane oxygenation (ECMO) can serve as a bridging therapy for critical patients when all medical treatments and conventional ventilation strategies fail. However, operating on a neonate with CDH during ECMO poses a unique challenge to paediatric surgeons. In the present study, we report our experience with Hong Kong’s first case of CDH repair under ECMO.

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Timing of repair of congenital diaphragmatic hernia in patients supported by extracorporeal membrane oxygenation (ECMO)

Cited by 66 publications

References 10 publications

Standardized Postnatal Management of Infants with Congenital Diaphragmatic Hernia in Europe: The CDH EURO Consortium Consensus - 2015 Update

Standardized Postnatal Management of Infants with Congenital Diaphragmatic Hernia in Europe: The CDH EURO Consortium Consensus - 2015 Update

Role of ECMO in congenital diaphragmatic hernia

Use of extracorporeal membrane oxygenation support for congenital diaphragmatic hernia repair: Bridging therapy for successful outcomes

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