SURGICAL REPAIR OF CONGENITAL DIAPHRAGMATIC-HERNIA DURING EXTRACORPOREAL MEMBRANE-OXYGENATION - HEMORRHAGIC COMPLICATIONS AND THE EFFECT OFTRANEXAMIC ACID

Extracorporeal membrane oxygenation (ECMO) was incorporated in a strat egy of delayed repair of congenital diaphragmatic hernia (CDH) and was used for preoperative stabilization in patients who were unresponsive to maximal conventional treatment. If ECMO was required for preoperat ive stabilization the diaphragmatic defect was repaired while the pati ent was on ECMO. In the early experience with this approach all patien ts suffered from bleeding complications. Therefore, we adopted the use of antifibrinolytic therapy with tranexamic acid (TEA) during and imm ediately after CDH repair on ECMO. The efficacy of TEA was studied in an unblinded study using historical controls by comparing the postoper ative blood loss and the transfusion requirements of red blood cells ( RBC) in patient groups treated without (n = 9) and with TEA (n = 10). Patients who received TEA had significantly less bleeding at the surgi cal site than patients not receiving TEA (57 v 390 mt, P = .005) and h ad significantly lower RBC transfusion requirements than patients not receiving TEA (1.13 v 2.95 mL/kg/h, P = .03). In the very first two pa tients of the TEA group we encountered fairly severe thrombotic compli cations. TEA may have contributed to those complications. Based on the authors' experience they conclude: (1) TEA is effective in reducing p ostoperative blood loss, hemorrhagic complications, and RBC transfusio n requirements associated with CDH repair on ECMO. (2) TEA may be resp onsible for thrombotic complications. (3) The appropriate, empirically established, dosage and administration patterns of TEA for CDH repair during ECMO seem to be one bolus of 4 mg/kg TEA intravenously 30 minu tes before the anticipated CDH repair and a continuous infusion of 1 m g/kg/h TEA during the 24 hours after CDH repair. Copyright (C) 1997 by W.B. Saunders Company.