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Management of Congenital Diaphragmatic Hernia Treated With Extracorporeal Life Support: Interim Guidelines Consensus
Yigit Guner1,2, Tim Jancelewicz3, Matteo Di Nardo4
1From the Division of Pediatric Surgery, Children's Hospital of Orange County, Orange, California.
Insights
Management of infants with congenital diaphragmatic hernia (CDH) using extracorporeal life support (ECLS) lacks clear guidelines. This report reviews evidence to create best practice recommendations for ECLS in CDH patients.
Area of Science:
- Neonatal medicine
- Pediatric surgery
- Critical care medicine
Background:
- Congenital diaphragmatic hernia (CDH) management in neonates requiring extracorporeal life support (ECLS) is challenging.
- Variability in ECLS use and management protocols exists across different medical centers.
- Lack of robust evidence complicates decision-making for ECLS in CDH.
Purpose of the Study:
- To review current evidence regarding ECLS for congenital diaphragmatic hernia.
- To develop evidence-based management recommendations for CDH patients undergoing ECLS.
- To standardize care for neonates with CDH requiring advanced life support.
Main Methods:
- Systematic review of existing literature on ECLS for CDH.
- Consensus development by expert groups including the Extracorporeal Life Support Organization (ELSO) CDH interest group.
- Collaboration with the CDH Study Group and Children's Hospitals Neonatal Consortium.
Main Results:
- Identification of key areas of practice variability in ECLS for CDH.
- Synthesis of evidence to support specific management strategies.
- Development of consensus-driven recommendations for patient selection, management, and outcomes.
Conclusions:
- Standardized management protocols are needed for infants with CDH on ECLS.
- Evidence-based recommendations can improve outcomes for this complex patient population.
- Multicenter collaboration is crucial for advancing the care of neonates with CDH.
Abstract:
The management of infants with congenital diaphragmatic hernia (CDH) receiving extracorporeal life support (ECLS) is complex. Significant variability in both practice and prevalence of ECLS use exists among centers, given the lack of evidence to guide management decisions. The purpose of this report is to review existing evidence and develop management recommendations for CDH patients treated with ECLS. This article was developed by the Extracorporeal Life Support Organization CDH interest group in cooperation with members of the CDH Study Group and the Children's Hospitals Neonatal Consortium.