Repeated Treatments With Extracorporeal Membrane Oxygenation in Congenital Diaphragmatic Hernia Patients: A Registry Analysis.

Abstract

Congenital diaphragmatic hernia (CDH) is a rare and severe malformation that can lead to life-threatening postnatal physiological challenges which may require lifesaving extracorporeal membrane oxygenation (ECMO) support, sometimes more than once. However, the benefits of multiple ECMO courses remain uncertain. Data on all patients with CDH supported on ECMO from 1976 to 2020 were retrieved from the Extracorporeal Life Support Organization (ELSO) Registry. Outcomes for patients with CDH undergoing more than one ECMO course were analyzed. This group was then stratified into two subgroups, "treated before 2010" and "treated after 2010," which were analyzed separately. A total of 9,928 patients were identified. The overall survival to discharge for CDH supported with ECMO was 51.9%. Three hundred and thirty-nine patients (3.5%) were supported with ECMO more than once. The overall survival to discharge in this group was 39%. After 2010, the survival rate had increased from 34.7 (n = 213) to 46.8% (n = 126) (p = 0.018). We found that the rate of CDH patients requiring repeated ECMO support was low, and that survival rates were acceptable and improving over time.