Repair of congenital diaphragmatic hernia during extracorporeal life support: Experience with six neonates

Prabhu, Sudesh, Mattke, Adrian C., Anderson, Ben, Mcbride, Craig, Cooke, Lucy, Karl, Tom and Alphonso, Nelson (2016) Repair of congenital diaphragmatic hernia during extracorporeal life support: Experience with six neonates. ANZ Journal of Surgery, . doi:10.1111/ans.13466


Author Prabhu, Sudesh
Mattke, Adrian C.
Anderson, Ben
Mcbride, Craig
Cooke, Lucy
Karl, Tom
Alphonso, Nelson
Title Repair of congenital diaphragmatic hernia during extracorporeal life support: Experience with six neonates
Journal name ANZ Journal of Surgery   Check publisher's open access policy
ISSN 1445-2197
1445-1433
Publication date 2016-02-14
Year available 2016
Sub-type Article (original research)
DOI 10.1111/ans.13466
Open Access Status Not Open Access
Total pages 6
Place of publication Richmond, VIC, Australia
Publisher Wiley-Blackwell Publishing Asia
Collection year 2017
Language eng
Formatted abstract
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.
Keyword Congenital diaphragmatic hernia
Extracorporeal life support
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Mater Research Institute-UQ (MRI-UQ)
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