J Pediatr Surg. 2020 Apr 19. pii: S0022-3468(20)30265-7. doi: 10.1016/j.jpedsurg.2020.04.005. [Epub ahead of print] https://pmlegacy.ncbi.nlm.nih.gov/pubmed/32620266
Re-ECMO for congenital diaphragmatic hernia: Is it worth the effort?
Mesas Burgos C1, Öst E2, Frenckner B3.
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Abstract
AIM:
To evaluate the results in CDH patients subjected to a second course of ECMO at a single institution.
MATERIAL AND METHODS:
Retrospective review of medical charts of patients treated for CDH and ECMO in our center since 1990 to December 2018 was performed. For patients subjected to a second course of ECMO and who survived to hospital discharge charts from follow up visits were also reviewed.
RESULTS AND DISCUSSION:
From Jan 1990 until December 2018, 311 patients with CDH were treated in the department. 267 of these (86%) were discharged alive from the hospital and 81% (237/293) of the Swedish patients were alive by December 2018. 101 patients (32%) were subjected to ECMO treatment of whom 71 survived (70%). 22 patients underwent a second ECMO run and 13 of these survived to hospital discharge. Seven of the Swedish patients [19] were long-term survivors (37%). The vast majority was on V-A ECMO.
CONCLUSIONS:
It is possible to recannulate the right common carotid artery and internal jugular vein for a second course of venoarterial ECMO in CDH patients, who deteriorate severely after decannulation. Previous research has shown that long-term survivors subjected to ECMO twice reported similar frequencies of pulmonary, gastrointestinal, neurological and musculoskeletal sequelae as the long-term survivors, who needed ECMO support only once, and similar health-related quality of life. Regarding their psychosocial function, they scored within normal range in the behavioral, emotional and social scales domains. A second ECMO run may contribute to a higher survival and that the long-term morbidity among survivors is not more pronounced than among survivors after a single course of ECMO. It is therefore suggested that a second course of ECMO should be offered on the same indications as the first course.
LEVEL OF EVIDENCE:
III Case series.
Copyright © 2020 Elsevier Inc. All rights reserved.
KEYWORDS:
Congenital diaphragmatic hernia (CDH); Extracorporeal membrane oxygenation (ECMO); Long-term; Recannulation; SurvivalPMID: 32620266 DOI: 10.1016/j.jpedsurg.2020.04.005
