Congenital diaphragmatic hernia: to repair on or off extracorporeal membrane oxygenation?

Abstract

BACKGROUND:

Congenital diaphragmatic hernia (CDH) can be repaired on or off extracorporeal membrane oxygenation (ECMO). In many centers, operating off ECMO is advocated to prevent bleeding complications. We aimed to compare surgery-related bleeding complications between repair on or off ECMO.

METHODS:

All patients with CDH repair and ECMO treatment between January 1, 1995, and May 31, 2008, were retrospectively reviewed. Tranexamic acid was routinely given to all patients repaired on ECMO for 24 hours perioperatively after 2003. Extra-fluid expansion, transfusion, or relaparotomy caused by postoperative bleeding were scored as surgery-related bleeding complications and were related to the Extracorporeal Life Support Organization (ELSO) registry. We used χ(2) test and t test for statistics.

RESULTS:

Demographic data and surgery-related bleeding complications in the on-ECMO group were not significantly different compared with the off-ECMO group (P = .331) in our institute. In contrast, more surgery-related bleeding complications were reported by ELSO in their on-ECMO group (P < .0001).

CONCLUSION:

In contrast to the data from the ELSO registry, we did not observe significantly more surgery-related bleeding complications after CDH repair on ECMO. Using a specific perioperative hemostatic treatment enabled us to perform CDH repair on ECMO with a low frequency of bleeding complications, thereby taking advantage of having the physiologic benefits of ECMO available perioperatively.

• Authors: Richard Keijzer, Dorien E Wilschut, Robert Jan Houmes, Kees P van de Ven, Lieke van den Hout, Ilona Sluijter, Peter Rycus, Klaas M Bax, Dick Tibboel
• Journal: Journal of pediatric surgery (J Pediatr Surg) Vol. 47 Issue 4 Pg. 631-6 (Apr 2012) ISSN: 1531-5037 [Electronic] United States
• PMID: 22498373 (Publication Type: Comparative Study, Evaluation Study, Journal Article)
• Copyright: Copyright © 2012 Elsevier Inc. All rights reserved.

Chemical References

• Antifibrinolytic Agents
• Tranexamic Acid

Topics

• Antifibrinolytic Agents (therapeutic use)
• Extracorporeal Membrane Oxygenation (methods)
• Female
• Hernia, Diaphragmatic (surgery)
• Hernias, Diaphragmatic, Congenital
• Herniorrhaphy (methods)
• Humans
• Infant, Newborn
• Male
• Postoperative Hemorrhage (prevention & control)
• Registries
• Retrospective Studies
• Tranexamic Acid (therapeutic use)
• Treatment Outcome