Optimizing Congenital Diaphragmatic Hernia (CDH) Repair on ECMO: Evaluating the Risk of Bleeding | Single-institution | Retrospective review | 2005 - 2023 | 46 patients | underwent CDH repair on ECMO | Male 72% (33) | Female 28% (13) | Primary repair 7% | Patch repair 93% | *Bleeding complication: bleeding necessitating re-operation | *Bleeding complication: 24% | Birthweight (2.5 vs. 3.2 kg) (p = 0.02) | Platelet count <100/mm³ (p = 0.04) | Elevated blood urea nitrogen (24.5 vs. 17.5 mg/dL) (p = 0.05) | Older age at repair (8 vs. 5 days) (p = 0.04) | Platelets <100/mm³: ⬆ bleeding complication (OR = 4.4, p = 0.04) | ⬆ ECMO days (12 vs. 7 days) (p < 0.01) | ⬆ Ventilator days (31 vs. 18 days) (p < 0.05) | Conclusion: CDH patients repaired on ECMO with low birth weight, platelets <100/mm³, high BUN, or older repair age face higher bleeding risks. Maintaining platelets >100/mm³ is recommended during on-ECMO repair. | https://pubmed.ncbi.nlm.nih.gov/39271309/ | Schmoke N et. al. | Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA | @EmGooteeMD | @StayCurrentMD | Cincinnati Children's | Journal of Pediatric Surgery
Optimizing Congenital Diaphragmatic Hernia Repair on ECMO: Evaluating the Risk of Bleeding
Infographic · Jan 2025 · 1 min read
In brief
In brief
This retrospective study of 46 CDH patients repaired on ECMO found that 24% experienced significant bleeding requiring reoperation. Platelet counts below 100/mm³, lower birthweight, elevated BUN, and delayed repair were associated with bleeding complications that resulted in prolonged ECMO support, increased ventilator days, and higher mortality.
- Platelet count <100/mm³ quadruples bleeding risk in CDH repair on ECMO; transfuse to >100/mm³ preoperatively
- Bleeding complications after on-ECMO CDH repair increase ECMO duration (12 vs 7 days) and double mortality risk
- Lower birthweight, elevated BUN, and delayed repair (8 vs 5 days) independently predict postoperative bleeding
- 24% of CDH patients repaired on ECMO develop bleeding requiring reoperation; early repair may reduce this risk
- High-risk patients (low platelets, elevated BUN, low birthweight) should be considered for earlier ECMO repair
Written by the GCMD Library team from the infographic.
The infographic uses a teal, white, and yellow color scheme with illustrated graphics of a hospital building and a caregiver holding an infant. Data is presented in sections with bullet points and statistical comparisons. Key findings are highlighted in colored text (red for complications, green/blue for risk factors). The bottom section contains a yellow conclusion banner.
Nicholas Schmoke, Anna Rose, Christopher Nemeh, Yeu Sanz Wu, Pengchen Wang, Paul Kurlansky, Cindy Neunert, William Middlesworth, Vincent Duron
Background: Institutions lack consensus on the management of patients with congenital diaphragmatic hernia (CDH) who are repaired on extracorporeal membrane oxygenation (ECMO). Our study aimed to evaluate risk factors associated with bleeding complications in patients with CDH repaired on ECMO.
Methods: A single-institution retrospective review evaluated all patients with CDH who underwent on-ECMO repair between January 2005 and December 2023. A significant bleeding complication post-repair was defined as bleeding necessitating re-operation. The association between preoperative factors and bleeding complications was evaluated.
Results: Forty-six patients were included. Bleeding complications developed in 11/46 (24%) patients. Birthweight (2.5 vs. 3.2 kg, p = 0.02), platelet count <100/mm3 (64% vs. 29%, p = 0.04), elevated blood urea nitrogen (BUN; 24.5 vs. 17.5 mg/dL, p = 0.05), and older age at repair (8 vs. 5 days, p = 0.04) were associated with bleeding. In univariate analysis, patients with platelets under 100/mm3 were more likely to develop a bleeding complication (OR = 4.4, p = 0.04). Patients who experienced a significant bleeding event experienced increased ECMO days (12 vs. 7 days, p < 0.01), ventilator days (31 vs. 18 days, p < 0.05), and lower survival to discharge (36% vs. 74%, p = 0.03).
Conclusion: Among CDH patients undergoing repair on ECMO, those with lower birth weight, platelet counts under 100/mm3, elevated BUN, and older age at repair had an increased risk of a significant bleeding complication, resulting in more ECMO and ventilator days and higher mortality. Patients undergoing on-ECMO repair should have platelet count transfused to greater than 100/mm3. Patients at high risk for bleeding may benefit from early repair on ECMO.