Objectives We conducted a meta-analysis of trials to determine the optimal time to conduct surgery for congenital diaphragmatic hernia (CDH) in infants, on or after weaning from extracorporeal membrane oxygenation (ECMO).

Methods We searched the PubMed, Embase, Scopus, and Cochrane Library databases to identify relevant articles published prior to May 2023 in which surgery was performed to treat CDH in infants. Data were collected, and continuous data were represented by the mean difference (MD) and 95% confidence interval (CI). Dichotomous data were represented by the odds ratio (OR) and 95% CI. Review Manager V.5.4 and Stata were used to synthesize results and to assess publication bias.

Results The results showed that infants undergoing surgery after being weaned from ECMO had reduced mortality (OR, 2.40; 95% CI, 1.23–4.69; p = 0.01) and postoperative bleeding rates (OR, 16.20; 95% CI, 5.73–45.76; p < 0.00001) and reduced ECMO duration (MD, 3.47; 95% CI, 1.89–5.05; p < 0.0001) compared with those who underwent surgery while on ECMO. There was no statistically significant difference in hospital duration (MD, 5.48; 95% CI, −8.66 to 19.62; p = 0.45) or ventilator duration (MD, −1.93; 95% CI, −8.55 to 4.68; p = 0.57).

Conclusion We recommend weaning patients with CDH from ECMO before performing surgery.

*Minhua Lin and Jiachi Liao are both the first authors, and they contributed equally to the article.

Received: 01 November 2023

Accepted: 08 December 2023

Accepted Manuscript online:
13 December 2023

Article published online:
23 January 2024

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