J Pediatr Surg
. 2026 Aug 21:163405.
doi: 10.1016/j.jpedsurg.2026.163405. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/42628596/
Decreasing the Post Surgical Ooze: Utilizing a Perioperative Guideline to Decrease Transfusion Needs Following Congenital Diaphragmatic Hernia Repair on ECMO
Kathleen Heller 1, Meriam J Avades 2, Navin Bhopal 2, Mohammed Elkhwad 2, Patrick McGovern 1, Sharad Menon 3, Mark S Molitor 1
Affiliations Expand
- PMID: 42628596
- DOI: 10.1016/j.jpedsurg.2026.163405
Abstract
Purpose: To evaluate changes in post-operative transfusion requirements of infants undergoing congenital diaphragmatic hernia (CDH) repair on ECMO following implementation of a perioperative guideline.
Methods: In 2021, a multidisciplinary team created a guideline for perioperative management of CDH repair on ECMO, including guidance on pre-operative lab values, antifibrinolytic dosing, transfusion recommendations, and anticoagulation titration. CDH repairs on ECMO from 2010 – 2024 were divided into Pre- and Post- Guideline groups. A retrospective cohort study comparing Pre- and Post- Guideline outcomes was performed utilizing descriptive statistics for analysis.
Results: Twenty-seven infants underwent CDH repair on ECMO within the study period: 16 Pre and 11 Post guideline implementation. Gestational age, weight, and day of life at cannulation did not differ. The Post group had higher Vasoactive-Inotropic Scores (Pre:10.5 versus Post:17.5, p=0.01) and underwent repair sooner after ECMO cannulation (Pre:3 (1,8) versus Post:1 (1,2) days, p=0.02). At 24-hours post-operatively, pRBC transfusions were lower in the Post group (Pre:121, (51,210) versus Post:60 (31, 90) mL, p=0.03) and platelet transfusions (Pre:93 (60,133) versus Post:50 (30,81) mL, p=0.004). Re-operation for re-bleeding occurred in 19% of infants Pre versus 9% of infants Post, p=0.62. Rate of intraventricular hemorrhages trended lower in the Post group (Pre:44% versus Post:9%, p=0.09). ECMO cannula clotting rates were similar. 13% of infants Pre and 55% of infants Post survived to hospital discharge, p=0.03.
Conclusion: Implementation of a perioperative guideline for procedures on ECMO was associated with reduced transfusion requirement and improved survival of these high-risk patients.
Level of evidence: Level 3 evidence.
Keywords: congenital diaphragmatic hernia; pediatric extracorporeal life support; standardized perioperative care.
Copyright © 2026. Published by Elsevier Inc.
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