Early CDH Repair on ECMO Improves Survival

Infographic · Dec 2019 · 1 min read

In brief

Multi-center study of 1,170 CDH patients demonstrates that early repair within 72 hours of ECMO cannulation significantly improves survival to decannulation (87.1% vs 78.4%) compared to remaining unrepaired, despite longer ECMO duration. Findings suggest physiologic benefit of early intervention in select patients.

Early CDH repair within 72h of ECMO cannulation increased survival to decannulation (87.1% vs 78.4%, p=0.002) despite higher-risk patient profiles.
Early repair group had longer median ECMO duration (240.6h vs 196.8h, p=0.001), suggesting survival benefit outweighs prolonged support time.
Patients repaired early had more adverse prognostic factors (cardiac defects, thoracic liver) yet still achieved superior survival outcomes.
Physiologic benefit of early repair may optimize pulmonary mechanics in select CDH patients better than delaying repair until after ECMO.
Level III evidence supports considering early on-ECMO repair strategy for appropriate CDH candidates requiring extracorporeal support.

Written by the GCMD Library team from the infographic.

Three-panel infographic with blue background. Each panel contains a white icon (infant with heart monitor, hands holding house, infant with clock) above outcome statistics displayed in large white text with upward arrows. The left and right panels show patient illustrations, while the center panel uses a symbolic representation of care/discharge.

“Early on-ECMO” repair of CDH entails repair within 48–72 h of cannulation in an effort to optimize pulmonary physiology, shorten ECMO duration, and, ultimately, improve survival. This study evaluated the effect of early on-ECMO repair as compared to leaving patients unrepaired during ECMO.

Methods

The CDH Study Group database was queried for CDH patients requiring ECMO who either underwent repair within the first 72 h after cannulation or remained unrepaired on ECMO. Primary outcomes were survival to decannulation and ECMO duration.

Results

A total of 248 patients underwent early repair and 922 remained unrepaired on ECMO. The early repair group had increased risk factors for poor outcomes, including higher odds of cardiac defects and thoracic liver location, and lower odds of hernia sac presence. Nonetheless, ECMO survival for the early repair group was 87.1% compared to 78.4% in the unrepaired group (p = 0.002). However, the early repair group had a longer median ECMO duration than the unrepaired group (240.6 vs 196.8 h, p = 0.001).

Conclusion

While early ECMO repair does not shorten ECMO duration, it results in increased survival to decannulation as compared to those unrepaired on ECMO. This suggests that there may be a physiologic benefit leading to increased ECMO survival in a subset of patients undergoing on-ECMO repair over those designated to undergo post-ECMO repair.