• Enrico Danzer, Matthew T Harting, Alex Dahlen, Mesas BurgosCarmenCDepartment of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden.Department of Women and Children's Health, Karolinska Institute, Stockholm, Sweden., Björn Frenckner, Kevin P Lally, Ashley H Ebanks, Krisa P van Meurs, and Congenital Diaphragmatic Hernia Study Group.
• Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA.
• Ann. Surg. 2023 Sep 1; 278 (3): e605e613e605-e613.

ObjectiveTo evaluate the impact of repeat extracorporeal life support (ECLS) on survival and in-hospital outcomes in the congenital diaphragmatic hernia (CDH) neonates.BackgroundDespite the widespread use of ECLS, investigations on multiple ECLS courses for CDH neonates are limited.MethodsThis is a retrospective cohort study of all ECLS-eligible CDH neonates enrolled in the Congenital Diaphragmatic Hernia Study Group registry between 1995 and 2019. CDH infants with estimated gestational age at birth <32 weeks and a birth weight <1.8 kg and/or with major cardiac or chromosomal anomalies were excluded. The primary outcomes were survival and morbidities during the index hospitalization.ResultsOf 10,089 ECLS-eligible CDH infants, 3025 (30%) received 1 ECLS course, and 160 (1.6%) received multiple courses. The overall survival rate for patients who underwent no ECLS, 1 ECLS course, and multicourse ECLS were 86.9±0.8%, 53.8±1.8%, and 43.1±7.7%, respectively. Overall ECLS survival rate is increased by 5.1±4.6% ( P =0.03) for CDH neonates treated at centers that conduct repeat ECLS compared with those that do not offer repeat ECLS. This suggests that there would be an overall survival benefit from increased use of multiple ECLS courses. Infants who did not receive ECLS support had the lowest morbidity risk, while survivors of multicourse ECLS had the highest rates of morbidities during the index hospitalization.ConclusionsAlthough survival is lower for repeat ECLS, the use of multiple ECLS courses has the potential to increase overall survival for CDH neonates. Increased use of repeat ECLS might be associated with improved survival. The potential survival advantage of repeat ECLS must be balanced against the increased risk of morbidities during the index hospitalization.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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