Re-ECMO for congenital diaphragmatic hernia: Is it worth the effort?
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In brief
In brief
Retrospective analysis of 311 CDH patients over 28 years found that repeat ECMO after initial decannulation achieved 59% survival to discharge, with long-term survivors showing similar morbidity and quality of life compared to single-ECMO patients. The study supports offering second ECMO courses using the same clinical indications as initial treatment.
Written by the GCMD Library team from the article.
Abstract
Aim
To evaluate the results in CDH patients subjected to a second course of ECMO at a single institution.
Material and methods
Retrospective review of medical charts of patients treated for CDH and ECMO in our center since 1990 to December 2018 was performed. For patients subjected to a second course of ECMO and who survived to hospital discharge charts from follow up visits were also reviewed.
Results and discussion
From Jan 1990 until December 2018, 311 patients with CDH were treated in the department. 267 of these (86%) were discharged alive from the hospital and 81% (237/293) of the Swedish patients were alive by December 2018. 101 patients (32%) were subjected to ECMO treatment of whom 71 survived (70%). 22 patients underwent a second ECMO run and 13 of these survived to hospital discharge. Seven of the Swedish patients [19] were long-term survivors (37%). The vast majority was on V-A ECMO.
Conclusions
It is possible to recannulate the right common carotid artery and internal jugular vein for a second course of venoarterial ECMO in CDH patients, who deteriorate severely after decannulation. Previous research has shown that long-term survivors subjected to ECMO twice reported similar frequencies of pulmonary, gastrointestinal, neurological and musculoskeletal sequelae as the long-term survivors, who needed ECMO support only once, and similar health-related quality of life. Regarding their psychosocial function, they scored within normal range in the behavioral, emotional and social scales domains. A second ECMO run may contribute to a higher survival and that the long-term morbidity among survivors is not more pronounced than among survivors after a single course of ECMO. It is therefore suggested that a second course of ECMO should be offered on the same indications as the first course.
Level of evidence
III Case series.