Potential survival benefit with repair of congenital diaphragmatic hernia (CDH) after extracorporeal membrane oxygenation (ECMO) in select patients: Study by ELSO CDH Interest Group

• Published in: Journal of pediatric surgery 2019-06, Vol.54 (6), p.1132-1137
• Main Authors: Delaplain, Patrick T., Harting, Matthew T., Jancelewicz, Tim, Zhang, Lishi, Yu, Peter T., Di Nardo, Matteo, Chen, Yanjun, Stein, James E., Ford, Henri R., Nguyen, Danh V., Guner, Yigit
• Format: Article
• Language: English
• Subjects: Congenital diaphragmatic hernia (CDH); Extracorporeal membrane oxygenation (ECMO); Extracorporeal Membrane Oxygenation - mortality; Hernias, Diaphragmatic, Congenital - mortality; Hernias, Diaphragmatic, Congenital - surgery; Herniorrhaphy - methods; Herniorrhaphy - mortality; Humans; Infant, Newborn; Propensity Score; Registries
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2019.02.052

Studying the timing of repair in CDH is prone to confounding factors, including variability in disease severity and management. We hypothesized that delaying repair until post-ECMO would confer a survival benefit. Neonates who underwent CDH repair were identified within the ELSO Registry. Patients were then divided into on-ECMO versus post-ECMO repair. Patients were 1:1 matched for severity based on pre-ECMO covariates using the propensity score (PS) for the timing of repair. Outcomes examined included mortality and severe neurologic injury (SNI). After matching, 2,224 infants were included. On-ECMO repair was associated with greater than 3-fold higher odds of mortality (OR 3.41, 95% CI: 2.84–4.09, p