Extracorporeal Membrane Oxygenation for Congenital Diaphragmatic Hernia: A Single Center Experience in Turkey

Objective: Extracorporeal membrane oxygenation (ECMO) is a temporary life-support modality offered for stabilizing neonates with congenital diaphragmatic hernia (CDH) who are in a critical condition and unresponsive to optimal medical therapy. The aim of this study was to examine our institutional outcomes of early CDH repair on ECMO. Materials and Methods: A total of 17 ECMO-supported patients with CDH were evaluated and the demographic, diagnostic, laboratory, clinical data, complications and outcome of the patients were reported. Results: The study consisted of 7 females and 10 males. Mean birth weight (BW) was 3107 g (range, 2360–3840 g). Median age of ECMO initiation was 2.1 days. In total four patients received VV ECMO. Other patients received VA ECMO via aortic and right atrial cannulation. The mean duration of ECMO was 25 days (range: 1-140 days). Six patients (35.2%) could be weaned from ECMO. The most common ECMO related complications were hemorrhage, disseminated intravascular coagulation (DIC) and limb ischemia (64.7%, 41.1% and 29.4%, respectively). Diaphragmatic defect was repaired via a subcostal incision in 12 of 13 patients. In 88.2% of patients diaphragmatic repair was performed with polytetrafluoroethylene patch. In 77% of patients early CDH repair was performed concomitantly with ECMO insertion. The survival rate was 17.6%. Conclusion: Early repair of CDH in neonates on ECMO can be associated with high rates of morbidity and mortality. However, ECMO may be considered a life-saving measure for patients with CDH who would have otherwise not been salvageable.