Our Summary

This study examined the use of ECMO (a life-support treatment for severe lung conditions) in patients with a birth defect called CDH (congenital diaphragmatic hernia). The researchers looked back at the cases of 11 patients who had ECMO treatment before their CDH was repaired over a seven-year period (2015-2021). They compared outcomes between two groups: those who had their CDH repaired with a less invasive procedure called thoracoscopy (Group A) and those who had a more invasive surgery called laparotomy (Group B).

Out of the 11 patients, 6 had the less invasive procedure and 5 had the more invasive one. Two of the patients in Group A had to switch to the more invasive procedure. One patient in Group A had their CDH come back, but none in Group B did. Two patients in Group B died within the first 60 days of their life, while none in Group A did.

The researchers concluded that there were no clear differences in blood gas measurements (which reflect how well the lungs are working) during the surgeries for patients who had ECMO treatment. They suggested that the less invasive procedure might be a good option for these patients, but emphasized that this is a preliminary finding based on a small number of patients.

FAQs

  1. What is the purpose of ECMO in the treatment of CDH?
  2. What were the results of the retrospective review of ECMO prior to CDH repair conducted from 2015 to 2021?
  3. Is thoracoscopic CDH repair recommended for patients after ECMO according to the study?

Doctor’s Tip

A helpful tip a doctor might tell a patient about congenital diaphragmatic hernia repair is to discuss with their healthcare provider the option of thoracoscopic repair after ECMO, as it may be a viable option with comparable intra-operative outcomes to traditional open repair. It is important to weigh the benefits and risks of each approach in order to determine the best course of action for the individual patient.

Suitable For

Patients with congenital diaphragmatic hernia (CDH) who require escalation treatment for hypoxic respiratory failure, such as ECMO, are typically recommended for surgical repair. In this study, patients who underwent ECMO prior to CDH repair were evaluated, with some patients undergoing thoracoscopic repair and others undergoing laparotomy. The results showed no significant difference in intra-operative blood gas parameters between the two groups, suggesting that thoracoscopic CDH repair may be considered in patients after ECMO. This study highlights the importance of individualized treatment approaches for patients with CDH, taking into consideration their specific clinical needs and response to treatment.

Timeline

  • Before congenital diaphragmatic hernia repair:

    • Patient is diagnosed with CDH either prenatally or after birth
    • Patient may require ECMO for hypoxic respiratory failure
    • Patient undergoes evaluation and preparation for surgery
    • Patient may undergo tests such as blood gas analysis, imaging studies, and respiratory function tests
    • Patient may be stabilized on ECMO prior to surgery

  • After congenital diaphragmatic hernia repair:

    • Patient undergoes surgical repair of the diaphragmatic hernia
    • Intra-operative blood gas parameters are monitored
    • Patient is closely monitored post-operatively for complications
    • Patient may require respiratory support and intensive care
    • Patient may experience a period of recovery and rehabilitation
    • Long-term follow-up may be needed to monitor for recurrence and assess outcomes

What to Ask Your Doctor

  1. What are the potential risks and benefits of undergoing ECMO prior to CDH repair?
  2. How will ECMO affect my baby’s blood gas parameters during surgery?
  3. What is the recurrence rate for CDH repair following ECMO?
  4. How does the choice between thoracoscopic repair and laparotomy impact outcomes for patients who have undergone ECMO?
  5. What is the expected recovery time and prognosis for my baby following CDH repair after ECMO?
  6. Are there any specific considerations or precautions to take into account for my baby’s post-operative care given their history of ECMO?

Reference

Authors: Budzanowski A, Loukogeorgakis S, Mullassery D, Blackburn S, Curry J, Ioannou I, Ali U, Cross K, Giuliani S, De Coppi P. Journal: Pediatr Surg Int. 2023 Jan 16;39(1):82. doi: 10.1007/s00383-022-05312-x. PMID: 36645513