• Duy T Dao, Carmen M Burgos, Matthew T Harting, Kevin P Lally, Pamela A Lally, Hong-An T Nguyen, Jay M Wilson, and Terry L Buchmiller.
• Department of Surgery, Boston Children's Hospital, Boston, MA.
• Ann. Surg. 2021 Jul 1; 274 (1): 186-194.

ObjectiveTo determine the optimal timing of congenital diaphragmatic hernia (CDH) repair after extracorporeal membrane oxygenation (ECMO) cannulation.Summary Background DataThe timing of CDH repair after ECMO cannulation remains a controversial topic due to studies with low power or strong selection bias.MethodsThis is a 2-aim retrospective cohort study based on the CDH Study Group registry for the period of 2007-2017. Aim 1-Compare On versus After ECMO repair. Aim 2-Compare Early versus Late repair on ECMO. In order to minimize selection bias and account for non-repairs, subjects in each aim were stratified into study groups based on their treatment center's characteristics. In each aim, the study groups were matched based on propensity score (PS). The main outcomes included mortality rate and incidence of non-repair.ResultsIn aim 1, 136 patients remained in each group after PS matching. Compared to the After ECMO group, patients in the On ECMO group demonstrated a lower mortality rate, hazard ratio (HR) 0.54 (0.38, 0.77) (P < 0.001), and lower incidence of non-repair, 5.9% versus 33.8% (P < 0.001). In aim 2, 77 patients remained in each group after PS matching. Compared to the Late group, Early repair of CDH on ECMO was associated with a lower mortality rate, HR 0.51 (0.33, 0.77) (P = 0.002), and lower incidence of non-repair, 9.1% versus 44.2% (P < 0.001).ConclusionsThe approach of early repair after ECMO cannulation is associated with improved survival compared to delayed surgical correction.Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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