The role of extracorporeal life support and timing of repair in infants with congenital diaphragmatic hernia

被引:0
|
作者
Gehle, Daniel B. [1 ]
Meyer, Logan C. [1 ]
Jancelewicz, Tim [1 ]
机构
[1] Univ Tennessee, Hlth Sci Ctr, Le Bonheur Childrens Hosp, Memphis, TN 38163 USA
关键词
Ecmo; Mortality; Congenital Abnormalities; Pediatrics; Thoracic Surgery; FREQUENCY OSCILLATORY VENTILATION; MEMBRANE-OXYGENATION ECMO; NITRIC-OXIDE USE; LIVER HERNIATION; DELAYED REPAIR; IMPROVE SURVIVAL; HOSPITAL VOLUME; CITIES; OUTCOMES; CDH;
D O I
10.1136/wjps-2023-000752
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Extracorporeal life support (ECLS) serves as a rescue therapy for patients with congenital diaphragmatic hernia (CDH) and severe cardiopulmonary failure, and only half of these patients survive to discharge. This costly intervention has a significant complication risk and is reserved for patients with the most severe disease physiology refractory to maximal cardiopulmonary support. Some contraindications to ECLS do exist such as coagulopathy, lethal chromosomal or congenital anomaly, very preterm birth, or very low birth weight, but many of these limits are being evaluated through further research. Consensus guidelines from the past decade vary in recommendations for ECLS use in patients with CDH but this therapy appears to have a survival benefit in the most severe subset of patients. Improved outcomes have been observed for patients treated at high-volume centers. This review details the evolving literature surrounding management paradigms for timing of CDH repair for patients receiving preoperative ECLS. Most recent data support early repair following cannulation to avoid non-repair which is uniformly fatal in this population. Longer ECLS runs are associated with decreased survival, and patient physiology should guide ECLS weaning and eventual decannulation rather than limiting patients to arbitrary run lengths. Standardization of care across centers is a major focus to limit unnecessary costs and improve short-term and long-term outcomes for these complex patients.
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页数:10
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