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Repair of congenital diaphragmatic hernia during extracorporeal life support: experience with six neonates
Author(s) -
Prabhu Sudesh,
Mattke Adrian C.,
Anderson Ben,
McBride Craig,
Cooke Lucy,
Karl Tom,
Alphonso Nelson
Publication year - 2016
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.13466
Subject(s) - medicine , congenital diaphragmatic hernia , extracorporeal membrane oxygenation , extracorporeal , life support , surgery , retrospective cohort study , intensive care medicine , pregnancy , fetus , genetics , biology
Background The management of congenital diaphragmatic hernia ( CDH ) in neonates has evolved considerably over the last three decades. Initial stabilization followed by surgical repair is the current standard of care. A subset fails to achieve adequate oxygenation with medical management, including the use of high frequency oscillation and inhaled nitric oxide. The mortality in this group exceeds 80% without additional management strategies. Extracorporeal life support ( ECLS ) is a well‐established modality for managing these neonates with CDH and has been shown to improve early survival in selected cases. Methods This is a retrospective analysis of six neonates with CDH who underwent repair during ECLS between September 2011 and November 2014. Results Of 24 admissions with CDH , there were six neonates (25%) who required ECLS . All the six had CDH repair during ECLS . There were no intra‐operative bleeding complications. There were no clotting complications related to stopping heparin during CDH repair. There was one hospital death. Five neonates were weaned from ECLS and discharged home. Conclusions Data from our small cohort of patients illustrate that early survival is possible in extremely compromised neonates who otherwise would have died without ECLS . Our experience demonstrates that CDH repair can safely be performed during ECLS . Use of ECLS , early repair during ECLS , lung protective ventilation strategies and aggressive management of pulmonary hypertension were associated with good early survival. ECLS should be considered as an integral part of therapeutic armamentarium for CDH in neonates.