The Timing of CDH Repair on ECMO impacts on surgical bleeding
Topic overview
Retrospective study of 146 CDH infants on ECMO demonstrates that early repair (within 48 hours) significantly reduces surgical bleeding risk compared to delayed repair (5% vs 36%), with elevated BUN identified as a strong predictor of bleeding complications. Early repair also shortened ECMO duration without affecting survival rates.
Key takeaways
- Early CDH repair (within 48h of ECMO cannulation) reduces surgical bleeding risk compared to delayed repair (5% vs 36%, OR 11.7).
- Elevated BUN at time of repair strongly predicts surgical bleeding (median 63 vs 9 mg/dL in bleeders vs non-bleeders).
- Early repair shortens ECMO duration (13 vs 18 days median) without compromising survival rates.
- Azotemia is a key modifiable risk factor—consider early repair before renal dysfunction develops on ECMO.
- Delaying CDH repair beyond 48h on ECMO increases bleeding complications requiring reoperative intervention.
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