J Pediatr Surg

. 2024 Aug 22:161766.

 doi: 10.1016/j.jpedsurg.2024.161766. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/39271309/

Optimizing Congenital Diaphragmatic Hernia Repair on ECMO: Evaluating the Risk of Bleeding

Nicholas Schmoke ¹, Anna Rose ², Christopher Nemeh ¹, Yeu Sanz Wu ¹, Pengchen Wang ³, Paul Kurlansky ⁴, Cindy Neunert ⁵, William Middlesworth ¹, Vincent Duron ⁶

Affiliations Expand

• PMID: 39271309
• DOI: 10.1016/j.jpedsurg.2024.161766

Abstract

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.

Level of evidence: Level III.

Keywords: Bleeding; Congenital diaphragmatic hernia; Extracorporeal membrane oxygenation.

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