Optimizing Congenital Diaphragmatic Hernia Repair on ECMO: Evaluating the Risk of Bleeding

Infographic · Jan 2025 · 1 min read

In brief

Retrospective study of 46 CDH patients repaired on ECMO identifies thrombocytopenia (<100K platelets), low birth weight, elevated BUN, and delayed repair as risk factors for postoperative bleeding requiring reoperation. Bleeding complications were associated with prolonged ECMO/ventilator support and reduced survival, supporting platelet transfusion >100K and consideration of early repair in high-risk patients.

Thrombocytopenia <100K increases bleeding risk 4.4-fold in CDH repair on ECMO; transfuse platelets to >100K preoperatively.
Lower birthweight, elevated BUN, and delayed repair (>5 days) are independent risk factors for postoperative bleeding complications.
Bleeding complications after on-ECMO CDH repair triple mortality (36% vs 74% survival) and prolong ECMO/ventilator duration significantly.
Early repair on ECMO may reduce bleeding risk in high-risk patients compared to delayed intervention.
24% of CDH patients repaired on ECMO experience bleeding requiring reoperation; preoperative optimization is critical.

Written by the GCMD Library team from the infographic.

A three-column comparison layout with medical illustrations of esophageal procedures. Each column contains anatomical diagrams in blue and pink tones showing the esophagus and surgical intervention site, accompanied by outcome statistics in text boxes below. The design uses a clean, clinical color palette with icons and percentage metrics for easy comparison.

Nicholas Schmoke, Anna Rose, Christopher Nemeh, Yeu Sanz Wu, Pengchen Wang, Paul Kurlansky, Cindy Neunert, William Middlesworth, Vincent Duron

Background: Institutions lack consensus on the management of patients with congenital diaphragmatic hernia (CDH) who are repaired on extracorporeal membrane oxygenation (ECMO). Our study aimed to evaluate risk factors associated with bleeding complications in patients with CDH repaired on ECMO.

Methods: A single-institution retrospective review evaluated all patients with CDH who underwent on-ECMO repair between January 2005 and December 2023. A significant bleeding complication post-repair was defined as bleeding necessitating re-operation. The association between preoperative factors and bleeding complications was evaluated.

Results: Forty-six patients were included. Bleeding complications developed in 11/46 (24%) patients. Birthweight (2.5 vs. 3.2 kg, p = 0.02), platelet count <100/mm3 (64% vs. 29%, p = 0.04), elevated blood urea nitrogen (BUN; 24.5 vs. 17.5 mg/dL, p = 0.05), and older age at repair (8 vs. 5 days, p = 0.04) were associated with bleeding. In univariate analysis, patients with platelets under 100/mm3 were more likely to develop a bleeding complication (OR = 4.4, p = 0.04). Patients who experienced a significant bleeding event experienced increased ECMO days (12 vs. 7 days, p < 0.01), ventilator days (31 vs. 18 days, p < 0.05), and lower survival to discharge (36% vs. 74%, p = 0.03).

Conclusion: Among CDH patients undergoing repair on ECMO, those with lower birth weight, platelet counts under 100/mm3, elevated BUN, and older age at repair had an increased risk of a significant bleeding complication, resulting in more ECMO and ventilator days and higher mortality. Patients undergoing on-ECMO repair should have platelet count transfused to greater than 100/mm3. Patients at high risk for bleeding may benefit from early repair on ECMO.

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