Potential survival benefit with repair of congenital diaphragmatic hernia (CDH) after extracorporeal membrane oxygenation (ECMO) in select patients: Study by ELSO CDH Interest Group
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Read the article on jpedsurg.org ↗Article · Mar 2019 · 1 min read
In brief
In brief
ELSO Registry analysis of 2,224 matched neonates with CDH demonstrates that delaying surgical repair until after ECMO decannulation is associated with significantly improved survival compared to on-ECMO repair (OR 3.41 for mortality with on-ECMO approach). Propensity score matching controlled for disease severity, suggesting timing of repair independently impacts outcomes in this critically ill population.
Written by the GCMD Library team from the article.
Purpose
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.
Methods
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).
Results
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