• Ian C Glenn, Sophia Abdulhai, Neil L McNinch, Pamela A Lally, Todd A Ponsky, Avraham Schlager, and Congenital Diaphragmatic Hernia Study Group.
• Department of Surgery, Akron Children's Hospital, 1 Perkins Sq, Ste 8400, Akron, OH, 44308, USA.
• Pediatr. Surg. Int. 2018 Jul 1; 34 (7): 721-726.

PurposeOptimal timing of congenital diaphragmatic hernia (CDH) repair in patients requiring extracorporeal membrane oxygenation (ECMO) remains controversial. The "late ECMO repair" is an approach where the patient, once deemed stable for decannulation, is repaired while still on ECMO to enable expeditious return to ECMO if surgery induces instability. The goal of this study was to investigate the potential benefit of this approach by evaluating the rate of return to ECMO after repair.MethodsThe CDH Study Group database was used to analyze CDH patients requiring ECMO support. The primary outcome was return to ECMO within 72 h of CDH repair among those repaired following ECMO decannulation ("post-ECMO" patients). Secondary outcomes were death within 72 h of repair and cumulative death and return to ECMO rate.ResultsA total of 668 patients were repaired post-ECMO decannulation. Six patients (0.9%) in the post-ECMO group required return to ECMO within 72 h of surgery and a total of 19 (2.8%) died or returned to ECMO within 72 h of surgery.ConclusionThe rate of return to ECMO and death following CDH repair is extremely low and does not justify the risks inherent to "on-ECMO" repair. Patients stable to come off ECMO should undergo repair after decannulation.

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