Transfer timing is not independently associated with ECMO utilization in outborn congenital diaphragmatic hernia: a severity-adjusted analysis.

PURPOSE: To evaluate whether time from birth to arrival at a tertiary extracorporeal membrane oxygenation (ECMO)-capable center is independently associated with ECMO utilization among outborn neonates with congenital diaphragmatic hernia (CDH). We hypothesized that longer transfer intervals would be associated with greater ECMO utilization after adjustment for disease severity and anatomic characteristics.

METHODS

We performed a retrospective cohort study of outborn neonates with CDH transferred to a tertiary neonatal intensive care unit with ECMO capability. Transfer interval was analyzed using multivariable logistic regression adjusting for CDHSG postnatal score and anatomic characteristics.

RESULTS

Among 46 neonates, 21 (45.7%) required ECMO and 25 (54.3%) did not. Infants requiring ECMO had greater CDHSG postnatal scores and more frequent intrathoracic liver herniation. After adjustment, transfer time was not independently associated with ECMO utilization (aOR 0.79, 95% CI 0.50-1.23). Intrathoracic liver herniation remained independently associated (aOR 8.65, 95% CI 1.52-49.38), whereas CDHSG score did not reach statistical significance.

CONCLUSION

Within the transfer intervals observed, transfer time was not independently associated with ECMO utilization. These findings suggest that transport duration alone may be less informative than underlying disease characteristics in this cohort.