O-143
SHOULD NEONATES WITH SEVERE CONGENITAL DIAPHRAGMATIC HERNIA BE GIVEN THE OPTION OF EXTRACORPOREAL MEMBRANE OXYGENATION? DO OR DO NOT, THERE IS NO TRY. OR IS THERE?

Objectives: Neonates with severe congenital diaphragmatic hernia requiring extracorporeal membrane oxygenation (ECMO) have a high rate of mortality. There is controversy regarding optimal time of surgical intervention. We present our data over a 24-year period.

Methods: We analysed data from our ELSO registry forms between 1991 and 2015 in order to determine the factors affecting survival outcome of repair of congenital diaphragmatic hernia with ECMO as a bridge to surgery and/or recovery.

Results: Ninety-eight neonates with congenital diaphragmatic hernia requiring ECMO were identified. In-hospital mortality was 32%. The overall mortality (47.9%) in our study was seen up to 7 months, after this point there was no mortality. There was no difference in survival in patients repaired using pre-, intra- or postoperative ECMO (P: 0.65). Requiring haemofiltration at any point was significantly associated with reduced survival (HR 2.4 [95% CI 1.3-4.3] P: 0.03) as was the presence of neurological complications (HR 3.8 [95% CI 1.7-8.7] P: 0.006). Age, APGAR score, mode of delivery, side, associated cardiac comorbidities, pH, pCO₂, pO₂, oxygen saturation, bicarbonate, mode of ECMO, NO₂ and bleeding were not associated with any survival difference.

Conclusion: We believe that all neonates with severe diaphragmatic hernia should be given the option of ECMO if clinically indicated. Provided they survive the initial postoperative period, these patients go on to have a sustained survival benefit.

Disclosure: No significant relationships.