The timing of surgery for congenital diaphragmatic hernia in infants receiving extracorporeal membrane oxygenation: a meta-analysis.

There is controversy regarding the timing of congenital diaphragmatic hernia surgery in infants receiving extracorporeal membrane oxygenation (ECMO). We conducted a meta-analysis of trials examining the optimal timing of surgery for congenital diaphragmatic hernia (CDH) in infants receiving ECMO. Compared to late surgery with ECMO, early repair surgery with ECMO reduced mortality (OR, 0.51; 95% CI 0.30-0.87; P = 0.01) and postoperative bleeding rates (OR, 0.25; 95% CI 0.11-0.54; P = 0.0004) and shortened ECMO duration (MD, - 2.15; 95% Cl, - 3.20 to - 1.09; P < 0.0001) and duration of hospitalization (MD, - 29.07; 95% Cl, - 44.55 to - 12.59; P = 0.0005). There were no significant differences in ventilator duration (MD, - 15.98; 95% CI, - 35.76 to 3.80; P = 0.11). For infants with CDH receiving ECMO, we recommend early repair surgery. Levels of evidence: Level III.