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Outcomes of congenital diaphragmatic hernia repair on extracorporeal life support

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Abstract

Purpose

Extracorporeal life support (ECLS) is applied to refractory pulmonary hypertension in congenital diaphragmatic hernia (CDH). We evaluate the single-center outcomes of infants with CDH to determine the utility of late repair on ECLS versus repair post-decannulation.

Methods

Records of infants with CDH (2004–2014) were retrospectively reviewed.

Results

CDH was diagnosed in 177 infants. Sixty six (37%) underwent ECLS, of which, 11 died prior to repair, 33 were repaired post-decannulation, and 22 were repaired on ECLS. Repair was delayed in patients on ECLS (19 versus 10 days, p < 0.001). Patients repaired on ECLS had longer ECLS runs (22 versus 12 days, p < 0.001) and higher rates of bleeding and mortality than those repaired post-decannulation. Survival was 54% in infants undergoing ECLS, 65% in those who underwent repair, 36% in those repaired during ECLS, and 85% in those who were decannulated prior to repair. Eighteen percent (N = 4) of deaths after repair on ECLS were attributable to surgical bleeding. The remainder was due to pulmonary hypertension or sepsis.

Conclusion

Infants who underwent CDH repair post-decannulation had excellent outcomes and no mortalities attributable to repair. Neonates who underwent repair on ECLS late on bypass had the lowest survival rate with only 18% of mortality in this cohort attributable to surgical bleeding.

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Authors and Affiliations

  1. Division of Pediatric Surgery, Children’s Hospital Los Angeles, 4650 Sunset Blvd, Mailstop 100, Los Angeles, CA, 90027, USA

    Jamie Golden, Nicole Jones, Jessica Zagory, Shannon Castle & David Bliss

Authors
  1. Jamie Golden
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  2. Nicole Jones
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  3. Jessica Zagory
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  4. Shannon Castle
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Correspondence to David Bliss.

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Golden, J., Jones, N., Zagory, J. et al. Outcomes of congenital diaphragmatic hernia repair on extracorporeal life support. Pediatr Surg Int 33, 125–131 (2017). https://doi.org/10.1007/s00383-016-4002-2

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