PMID- 30898399
OWN - NLM
STAT- MEDLINE
DCOM- 20190826
LR  - 20190826
IS  - 1531-5037 (Electronic)
IS  - 0022-3468 (Linking)
VI  - 54
IP  - 6
DP  - 2019 Jun
TI  - Potential survival benefit with repair of congenital diaphragmatic hernia (CDH) 
      after extracorporeal membrane oxygenation (ECMO) in select patients: Study by 
      ELSO CDH Interest Group.
PG  - 1132-1137
LID - S0022-3468(19)30193-9 [pii]
LID - 10.1016/j.jpedsurg.2019.02.052 [doi]
AB  - PURPOSE: Studying the timing of repair in CDH is prone to confounding factors, 
      including variability in disease severity and management. We hypothesized that 
      delaying repair until post-ECMO would confer a survival benefit. METHODS: 
      Neonates who underwent CDH repair were identified within the ELSO Registry. 
      Patients were then divided into on-ECMO versus post-ECMO repair. Patients were 
      1:1 matched for severity based on pre-ECMO covariates using the propensity score 
      (PS) for the timing of repair. Outcomes examined included mortality and severe 
      neurologic injury (SNI). RESULTS: After matching, 2,224 infants were included. 
      On-ECMO repair was associated with greater than 3-fold higher odds of mortality 
      (OR 3.41, 95% CI: 2.84-4.09, p<0.01). The odds of SNI was also higher for on-ECMO 
      repair (OR 1.49, 95% CI: 1.13-1.96, p<0.01). A sensitivity analysis was performed 
      by including the length of ECMO as an additional matching variable. On-ECMO 
      repair was still associated with higher odds of mortality (OR 2.38, 95% CI: 
      1.96-2.89, p<0.01). Results for SNI were similar but were no longer statistically 
      significant (OR 1.33, 95% CI: 0.99-1.79, p=0.06). CONCLUSIONS: Of the infants who 
      can be liberated from ECMO and undergo CDH repair, there is a potential survival 
      benefit for delaying CDH repair until after decannulation. TYPE OF STUDY: 
      Treatment Study LEVEL OF EVIDENCE: III.
CI  - Copyright (c) 2019 Elsevier Inc. All rights reserved.
FAU - Delaplain, Patrick T
AU  - Delaplain PT
AD  - Children's Hospital Los Angeles, Department of Pediatric Surgery, Los Angeles, 
      CA; University of California Irvine Medical Center, Department of Surgery, 
      Orange, CA.
FAU - Harting, Matthew T
AU  - Harting MT
AD  - Department of Pediatric Surgery, University of Texas McGovern Medical School and 
      Children's Memorial Hermann Hospital, Houston, TX.
FAU - Jancelewicz, Tim
AU  - Jancelewicz T
AD  - Le Bonheur Children's Hospital, University of Tennessee Health Science Center, 
      Division of Pediatric Surgery, Memphis, TN.
FAU - Zhang, Lishi
AU  - Zhang L
AD  - University of California Irvine Biostatistics, Institute for Clinical and 
      Translational Science, Irvine, CA.
FAU - Yu, Peter T
AU  - Yu PT
AD  - University of California Irvine Medical Center, Department of Surgery, Orange, 
      CA; Children's Hospital of Orange County, Division of Pediatric Surgery, Orange, 
      CA.
FAU - Di Nardo, Matteo
AU  - Di Nardo M
AD  - Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Ospedale 
      Pediatrico Bambino Gesu, IRCCS, Rome, Italy.
FAU - Chen, Yanjun
AU  - Chen Y
AD  - University of California Irvine Biostatistics, Institute for Clinical and 
      Translational Science, Irvine, CA.
FAU - Stein, James E
AU  - Stein JE
AD  - Children's Hospital Los Angeles, Department of Pediatric Surgery, Los Angeles, 
      CA.
FAU - Ford, Henri R
AU  - Ford HR
AD  - Children's Hospital Los Angeles, Department of Pediatric Surgery, Los Angeles, 
      CA; University of Miami, Miller School of Medicine, Miami, FL.
FAU - Nguyen, Danh V
AU  - Nguyen DV
AD  - University of California, Irvine School of Medicine, Department of Medicine, 
      Orange, CA.
FAU - Guner, Yigit
AU  - Guner Y
AD  - University of California Irvine Medical Center, Department of Surgery, Orange, 
      CA; Children's Hospital of Orange County, Division of Pediatric Surgery, Orange, 
      CA. Electronic address: yguner@uci.edu.
LA  - eng
PT  - Journal Article
DEP - 20190301
PL  - United States
TA  - J Pediatr Surg
JT  - Journal of pediatric surgery
JID - 0052631
MH  - Extracorporeal Membrane Oxygenation/*mortality
MH  - *Hernias, Diaphragmatic, Congenital/mortality/surgery
MH  - *Herniorrhaphy/methods/mortality
MH  - Humans
MH  - Infant, Newborn
MH  - Propensity Score
MH  - Registries
OTO - NOTNLM
OT  - Congenital diaphragmatic hernia (CDH)
OT  - Extracorporeal membrane oxygenation (ECMO)
EDAT- 2019/03/23 06:00
MHDA- 2019/08/27 06:00
CRDT- 2019/03/23 06:00
PHST- 2019/02/02 00:00 [received]
PHST- 2019/02/21 00:00 [accepted]
PHST- 2019/03/23 06:00 [pubmed]
PHST- 2019/08/27 06:00 [medline]
PHST- 2019/03/23 06:00 [entrez]
AID - S0022-3468(19)30193-9 [pii]
AID - 10.1016/j.jpedsurg.2019.02.052 [doi]
PST - ppublish
SO  - J Pediatr Surg. 2019 Jun;54(6):1132-1137. doi: 10.1016/j.jpedsurg.2019.02.052. 
      Epub 2019 Mar 1.