Evidence map›Paper›PMID 30132059›Full record

ArticlePediatric surgery international2018

Controversies in extracorporeal membrane oxygenation (ECMO) utilization and congenital diaphragmatic hernia (CDH) repair using a Delphi approach: from the American Pediatric Surgical Association Critical Care Committee (APSA-CCC).

Sarah B Cairo, Mary Arbuthnot, Laura A Boomer, Michael W Dingeldein, Alexander Feliz, Samir Gadepalli, Chris R Newton, Robert Ricca, Adam M Vogel, David H Rothstein and 1 more

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Article in Pediatric surgery international, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

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5citing papers in PubMed
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1 · What the graph read from it

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

11 authors.

Sarah B CairoDepartment of Pediatric Surgery, John R. Oishei Children's Hospital, 1001 Main Street, Buffalo, NY, 14203, USA. scairo2@gmail.com.
Mary ArbuthnotDepartment of Pediatric and General Surgery, Naval Medical Center Portsmouth, Portsmouth, USA.
Laura A BoomerDepartment of Surgery, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, USA.
Michael W DingeldeinDepartment of Pediatric Surgery, Rainbow Babies and Children Hospital, Cleveland, USA.
Alexander FelizDepartment of Pediatric Surgery, University of Tennessee Health Sciences, Memphis, USA.
Samir GadepalliC.S. Mott Children's Hospital, Michigan Medicine, Ann Arbor, USA.
Chris R NewtonDepartment of Pediatric Surgery, University of California at San Francisco Benioff Children's Hospital Oakland, San Francisco, USA.
Robert RiccaDepartment of Pediatric and General Surgery, Naval Medical Center Portsmouth, Portsmouth, USA.
Adam M VogelDepartment of Pediatric General Surgery, Texas Children's Hospital, Houston, USA.
David H RothsteinDepartment of Pediatric Surgery, John R. Oishei Children's Hospital, 1001 Main Street, Buffalo, NY, 14203, USA.
American Pediatric Surgical Association, Surgical Critical Care Committee

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeReview current practices and expert opinions on contraindications to extracorporeal membrane oxygenation (ECMO) in congenital diaphragmatic hernia (CDH) and contraindications to repair of CDH following initiation of ECMO.

methodsModified Delphi method was employed to achieve consensus among members of the American Pediatric Surgical Association Critical Care Committee (APSA-CCC).

resultsOverall response rate was 81% including current and former members of the APSA-CCC. An average of 5-15 CDH repairs were reported annually per institution; 26-50% of patients required ECMO. 100% of respondents would not offer ECMO to a patient with a complex or unrepairable cardiac defects or lethal chromosomal abnormality; 94.1% would not in the setting of severe intracranial hemorrhage (ICH). 76.5% and 72.2% of respondents would not offer CDH repair to patients on ECMO with grade III-IV ICH or new diagnosis of lethal genetic or metabolic abnormalities, respectively. There was significant variability in whether or not to repair CDH if unable to wean from ECMO at 4-5 weeks.

conclusionsSignificant variability in practice pattern and opinions exist regarding contraindications to ECMO and when to offer repair of CDH for patients on ECMO. Ongoing work to evaluate outcomes is needed to standardize management and minimize potentially futile interventions. LEVEL OF EVIDENCE: V (expert opinion).

Indexed as

Extracorporeal Membrane OxygenationPractice Patterns, Physicians'CanadaChromosome AberrationsContraindicationsContraindications, ProcedureDelphi TechniqueHeart Defects, CongenitalHernias, Diaphragmatic, CongenitalHumansIntracranial HemorrhagesMedical FutilityPediatricsSurveys and QuestionnairesUnited StatesCDHCongenital diaphragmatic herniaECMOExtracorporeal membrane oxygenationPediatric surgery

Identifiers

PMID30132059

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.