Hemorrhage after on-ECMO repair of CDH is equivalent for muscle flap and prosthetic patch
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Read the article on jpedsurg.org ↗Article · May 2019 · 1 min read
In brief
In brief
Retrospective study of 29 patients comparing bleeding complications between prosthetic patch and muscle flap repair techniques for severe CDH performed on ECMO. Both repair methods showed equivalent hemorrhage risk, with similar intraoperative blood loss, reoperation rates, and transfusion requirements.
Written by the GCMD Library team from the article.
Background/Purpose
Prosthetic patch (patch) and muscle flap (flap) techniques are utilized for severe congenital diaphragmatic hernia (CDH) repair; however, when performed on extracorporeal membrane oxygenation (ECMO), the risk of hemorrhage increases. We sought to compare bleeding complications between repair types.
Methods
We retrospectively reviewed 2010–2016 on-ECMO CDH repairs.
Results
Twenty-nine patients met criteria: 13 patch (44.8%) and 16 flap (55.2%). Eight patch (61.5%) and 13 flap (81.2%) patients had left-sided defects (p = 0.223). All defects were Type C or D (Type C: patch 53.8%, flap 56.2%, p = 0.596). There was no difference in gestational age at delivery (patch 37.5 ± 0.9 weeks, flap 37.2 ± 1.3 weeks, p = 0.390) or age at repair (patch 7.46 ± 6.6 days, flap 6.00 ± 4.3 days, p = 0.476). Seven patch (53.8%) and 9 flap (56.2%) patients survived to discharge (p = 0.596). Estimated intraoperative blood loss was equivalent (patch 35.3 ± 53.9 mL, flap 24.2 ± 18.4 mL, p = 0.443). One patch patient (7.6%) and two (12.5%) flap patients required reoperation in the first 48 h for bleeding (p = 0.580). 48-h postoperative transfusions were the same for those that required reoperation (patch 282.0 mL/kg, flap 208.5 ± 21.9 mL/kg, p = 0.054) and those that did not (patch 120.7 ± 111.7 mL/kg, flap 118.4 ± 89.9 mL/kg, p = 0.561).
Conclusions
On-ECMO bleeding complications are equivalent for both flap and patch CDH repair.
Level of evidence
Type III (retrospective comparative study)