Our Summary

This research paper is about the best time to perform surgery on infants with a birth defect called congenital diaphragmatic hernia who need a specific life-support treatment known as extracorporeal membrane oxygenation (ECMO).

The researchers looked at 884 papers and concluded that the best results are achieved when the surgery is done after the baby has been weaned off the ECMO treatment. This approach was linked to higher survival rates, shorter use of ECMO, and fewer bleeding problems.

However, if the baby cannot be weaned off ECMO, the surgery should be done as soon as possible (within 72 hours of starting ECMO). This early surgery approach also led to better survival rates, less bleeding, shorter ECMO use and fewer changes to the ECMO setup compared to doing the surgery later on.

The researchers also found that closely monitoring the baby’s blood clotting ability and using certain drugs during surgery helped reduce the risk of bleeding.

FAQs

  1. What is the best time to perform surgery on infants with congenital diaphragmatic hernia who are on ECMO treatment according to the research?
  2. What happens if the baby cannot be weaned off ECMO? When should the surgery be performed in that case?
  3. What strategies were found to reduce the risk of bleeding during the surgery for congenital diaphragmatic hernia?

Doctor’s Tip

Therefore, a helpful tip a doctor might tell a patient about congenital diaphragmatic hernia repair is to discuss with the medical team the best timing for surgery based on the baby’s response to ECMO treatment. It is important to closely monitor the baby’s blood clotting ability and follow the recommendations of the medical team to optimize the outcome of the surgery. Early surgery within 72 hours of starting ECMO may be necessary if the baby cannot be weaned off ECMO, but if possible, waiting until after weaning off ECMO may lead to better outcomes. Additionally, discuss with the medical team about using certain drugs during surgery to reduce the risk of bleeding.

Suitable For

Patients with congenital diaphragmatic hernia who are recommended for surgery typically include infants who require ECMO treatment, as well as those who are unable to be weaned off ECMO. The optimal timing for surgery may vary depending on the individual patient’s condition and response to treatment, but early intervention within 72 hours of starting ECMO has been shown to lead to better outcomes in terms of survival rates, bleeding complications, and ECMO duration. Close monitoring of blood clotting ability and appropriate medication management during surgery are also important factors in reducing the risk of complications and improving overall outcomes for patients with congenital diaphragmatic hernia.

Timeline

Before congenital diaphragmatic hernia repair:

  • Baby is diagnosed with congenital diaphragmatic hernia either prenatally or shortly after birth
  • Baby may require respiratory support and other treatments to stabilize their condition
  • If ECMO is needed, the baby will be placed on this life-support treatment
  • Surgery may be scheduled once the baby is stable enough for the procedure

After congenital diaphragmatic hernia repair:

  • Surgery is performed to repair the hernia and restore the diaphragm
  • Baby may require continued respiratory support and monitoring in the ICU post-surgery
  • If ECMO was used, the baby will be weaned off the treatment gradually
  • Close monitoring of blood clotting ability and use of certain drugs to prevent bleeding complications
  • Baby will continue to be monitored for any potential complications and undergo follow-up appointments with their medical team.

What to Ask Your Doctor

Some questions a patient should ask their doctor about congenital diaphragmatic hernia repair include:

  1. What is the best timing for surgery for my baby with congenital diaphragmatic hernia who may require ECMO treatment?
  2. What are the potential risks and benefits of delaying surgery until after ECMO weaning versus performing surgery early while the baby is still on ECMO?
  3. How will you monitor my baby’s blood clotting ability during surgery and what steps will be taken to minimize the risk of bleeding?
  4. What factors will determine whether my baby can be weaned off ECMO before surgery is performed?
  5. What are the expected outcomes and recovery time for my baby following congenital diaphragmatic hernia repair surgery?
  6. Are there any specific medications or treatments that should be considered before or after surgery to optimize my baby’s recovery?
  7. How will you communicate and coordinate care with other members of the medical team involved in my baby’s treatment, including ECMO specialists?
  8. What follow-up care and monitoring will be necessary for my baby after surgery to ensure long-term success and optimal health outcomes?

Reference

Authors: Low ZK, Tan ASM, Nakao M, Yap KH. Journal: Interact Cardiovasc Thorac Surg. 2021 Apr 19;32(4):632-637. doi: 10.1093/icvts/ivaa303. PMID: 33291145