Does V-A ECMO increase the likelihood of chylothorax after congenital diaphragmatic hernia repair?

• Published in: Journal of pediatric surgery 2003-06, Vol.38 (6), p.971-974
• Main Authors: Hanekamp, M.N, Tjin A Djie, G.C.M, van Hoek-Ottenkamp, W.G, Hazebroek, F.W.J, Tibboel, D, Postema, R.R
• Format: Article
• Language: English
• Subjects: Artificial Organs - adverse effects; Artificial Organs - statistics & numerical data; Biological and medical sciences; Birth Weight; chylothorax; Chylothorax - diagnosis; Chylothorax - epidemiology; Congenital diaphragmatic hernia; Esophageal Atresia - complications; Esophageal Atresia - surgery; extracorporeal membrane oxygenation; Extracorporeal Membrane Oxygenation - adverse effects; Extracorporeal Membrane Oxygenation - methods; Extracorporeal Membrane Oxygenation - statistics & numerical data; Female; Gestational Age; Hernia, Diaphragmatic - surgery; Hernias, Diaphragmatic, Congenital; Humans; Infant, Newborn; Likelihood Functions; Male; Medical sciences; Pneumology; Postoperative Complications - diagnosis; Postoperative Complications - etiology; Respiratory system : syndromes and miscellaneous diseases; Umbilical Arteries - metabolism; Umbilical Veins - metabolism
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/S0022-3468(03)00136-2

Background: The authors noticed a relatively large number of patients with congenital diaphragmatic hernia (CDH) repair after extracorporeal membrane oxygenation (ECMO) who had a chylothorax (CT). The data are reviewed. Methods: The charts of patients from 1990 until 2000 with CDH, treated with or without ECMO, together with the charts of patients treated with ECMO for other reasons and patients with esophageal atresia (EA) repair were reviewed. The diagnosis of CT was made if aspirated fluid appeared chylous and contained more than 90% lymphocytes or if the triglyceride level was more than 1.50 mmol/L. Results: Eighty-nine patients with CDH were analyzed. Postoperatively, 10% had a CT—21% in CDH patients with ECMO treatment and 6% in CDH patients without ECMO treatment. This difference appeared to be significant ( P < .05). The presence of a patch as independent variable for the development of CT also showed significance ( P < .05). Conclusions: Chylothorax presented in almost all cases as a left-sided fluid accumulation, and a patch was present in the majority of patients with CDH. Therefor, CT should be considered the result of the severity of the defect rather than the consequence of ECMO as a therapeutic modality.