Impact of Repeat Extracorporeal Life Support on Mortality and short-term in-hospital Morbidities in Neonates with Congenital Diaphragmatic Hernia

To evaluate the impact of repeat extracorporeal life support (ECLS) on survival and in-hospital outcomes in congenital diaphragmatic hernia (CDH) neonates.Despite the widespread use of ECLS, investigations on multiple ECLS courses for CDH neonates are limited.This is a retrospective cohort study of all ECLS-eligible CDH neonates enrolled in the CDH 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.Of 10,089 ECLS-eligible CDH infants, 3025 (30%) received one ECLS course, and 160 (1.6%) received multiple courses. The overall survival rate for patients who underwent no ECLS, one ECLS course, and multi-course 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 to 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 multi-course ECLS had the highest rates of morbidities during the index hospitalization.Although 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.