Congenital diaphragmatic hernia repair in patients on extracorporeal membrane oxygenation: How early can we repair?
J Pediatr Surg
; 54(1): 50-54, 2019 Jan.
Article
em En
| MEDLINE
| ID: mdl-30482539
ABSTRACT
BACKGROUND:
The benefits to early repair (<72â¯h postcannulation) of infants with congenital diaphragmatic hernia (CDH) on extracorporeal membrane oxygenation (ECMO) are increasingly recognized. Yet it is not known if even earlier repair (<24â¯h) results in comparable or improved patient outcomes. The goal of this study was to compare "super-early" (<24â¯h) to early repair (24-72â¯h) of CDH patients on ECMO.METHODS:
A retrospective review of infants with CDH placed on ECMO (2004-2017; nâ¯=â¯72) was performed. Data collected on the patients repaired while on ECMO within 72â¯h of cannulation (nâ¯=â¯33) included pre- and postnatal disease severity stratification variables and postnatal outcomes. Comparison groups were those patients repaired within 24â¯h of cannulation (nâ¯=â¯14) and those repaired between 24 and 72â¯h postcannulation (nâ¯=â¯19).RESULTS:
Patients undergoing "super-early" (<24â¯h) repair had an average survival of 71.4% compared to the average survival of 59.7% in the early repair group. Pre- and postnatal variables predicting disease severity were not significantly different between the groups. Mean hospital stays, ventilator days, and cannulation days were statistically similar between the groups.CONCLUSIONS:
Repair of patients with CDH patients on ECMO at less than 24â¯h postcannulation achieves outcomes that are comparable to those of repair between 24 and 72â¯h. While the present data suggest that there is not a "too early" time point for CDH repair on ECMO, larger multicenter studies are needed to validate our findings and determine the overall benefits. TYPE OF STUDY Retrospective comparative study. LEVEL OF EVIDENCE Level III.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Oxigenação por Membrana Extracorpórea
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Herniorrafia
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Tempo para o Tratamento
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Hérnias Diafragmáticas Congênitas
Tipo de estudo:
Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Female
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Humans
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Male
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Newborn
Idioma:
En
Revista:
J Pediatr Surg
Ano de publicação:
2019
Tipo de documento:
Article
País de afiliação:
Estados Unidos