Variation in practice and outcomes of extracorporeal life support (ECLS) in congenital diaphragmatic hernia (CDH) between North American and European centres

BACKGROUND: Previous studies suggest discrepancy between North American and European centres in use of extracorporeal life support (ECLS) in infants with congenital diaphragmatic hernia (CDH). The impact of this on outcomes is unknown. We aimed to compare indications, management and outcomes of infants with CDH receiving ECLS between North American and European centres. METHODS: ECLS organisation (ELSO) prospective registry study including infants with CDH receiving ECLS over 11 years starting January 2012. Outcomes were mortality, ECLS-related complications and length of inpatient stay. Propensity score weighted analysis adjusted for differences in infant and disease-related factors. RESULTS: There were 3,087 infants, with 2382 (77.1%) infants treated in North American centres while 705 (22.9%) were treated at European centres with similar birth demographics. Case volume per year was less for those treated in North American centres compared to European centres (4 [IQR 2-7, range 1-34] vs 5 [IQR 3-15, range 1-35] cases per year, p < 0.001). Unadjusted mortality was greater in North American infants (OR 1.40 [95% CI 1.18 to 1.66]) but similar after propensity score matching and adjustment for treatment factors (OR 0.93 [95% CI 0.70 to 1.22]). After propensity matching and adjustment, complication rate (OR 1.51 [1.15 to 1.97]) was greater and length of stay in survivors was longer (mean difference 38.6 [29.4 to 47.7] days) in North America. CONCLUSIONS: Infants with CDH selected for ECLS had greater physiological derangement in North America than Europe and several differences were identified in management strategies. Further work is required to explore reasons for the increased ECLS-related complication rate and length of stay observed in North American infants.