Optimizing ECLS strategies in the management of congenital diaphragmatic hernia: Recent advances and best practices

Area of Science:

• Neonatal Medicine
• Pediatric Surgery
• Cardiopulmonary Support

Background:

• Congenital diaphragmatic hernia (CDH) presents severe pulmonary hypoplasia, hypertension, and cardiac dysfunction in infants.
• This condition poses significant management challenges in neonatal intensive care.
• Extracorporeal life support (ECLS) has emerged as a critical intervention for severe CDH cases.

Purpose of the Study:

• To review recent advancements in ECLS for congenital diaphragmatic hernia.
• To highlight progressive strategies enhancing ECLS efficacy in CDH management.
• To underscore the need for standardized, evidence-based approaches.

Main Methods:

• Review of current literature on ECLS in congenital diaphragmatic hernia.
• Analysis of evolving indications, technologies, and clinical strategies for ECLS.
• Synthesis of data on ECLS's role in neonatal stabilization and management.

Main Results:

• ECLS has evolved significantly, improving stabilization and outcomes for high-risk CDH infants.
• Despite its foundational role, variability in ECLS approaches persists across centers.
• Ongoing equipoise exists regarding optimal timing and criteria for ECLS initiation.

Conclusions:

• ECLS remains a cornerstone for managing the most severe congenital diaphragmatic hernia cases.
• Further research and evidence development are crucial for refining ECLS strategies.
• Standardized, evidence-based approaches are needed to optimize ECLS use in CDH.