Summary of existing national consensus guidelines on use of ECLS in patients with CDH
| Organization | Origin | Date of publication | Key CDH-ECLS recommendations | Strength of agreement or recommendation | Level of evidence |
| American Pediatric Surgery Association | USA | 2015 | Assumed survival benefit of ECLS in patients with CDH | N/A | N/A |
| No survival advantage for VA versus VV mode ECLS | Grade C (A to D) | Class 3–4 (case–control studies, case series) | |||
| Arbitrary ECLS run lengths should be avoided; up to 4 weeks with acceptable survival | Grade D (A to D) | Class 4 (case series, expert opinion) | |||
| Canadian CDH Collaborative | Canada | 2023 | ECLS indications: respiratory or circulatory failure or acute clinical deterioration (agreement with ELSO) | N/A | N/A |
| Prenatal counseling for families of patients with prenatal CDH diagnosis regarding possibility of ECLS | Good agreement (3 out of 4) | Level B (non-randomized data) | |||
| Timing of repair: CDH repair should be avoided until after ECLS decannulation; palliation versus surgery for those unable to wean off ECLS | Good agreement (3 out of 4) | Level B (non-randomized data) | |||
| Contraindications: ECLS may be considered in populations with size/age or comorbidity contraindications under special circumstances (experimental scenarios or high-volume centers) | Weak agreement (2 out of 4) | Level C (limited data) | |||
| Timing of repair: Patients with low probability of survival based on prenatal predictors or severity of cardiopulmonary derangement at cannulation may benefit from early repair | Good agreement (3 out of 4) | Level B (non-randomized data) | |||
| Euro CDH Consortium | Multinational | 2015 | ECLS indications: based on values for oxygenation, blood gas, and ventilatory parameters, refractory hypotension, or decreased urine output | Grade D (A to D) | Not provided |
| Timing of repair: CDH repair should be attempted after clinical stabilization, with definitions based on blood pressure, preductal SpO2, FiO2, serum lactate, and urine output | Grade D (A to D) | Not provided | |||
| Extracorporeal Life Support Organization (ELSO) | Multinational | 2021 | ECLS indications: hypoxic or hypercapnic respiratory failure, circulatory failure, or acute clinical deterioration | N/A | N/A |
| Contraindications: gestational age <32 weeks, birth weight <1.7–2.0 kg, major genetic abnormalities/syndromes (relative). Severe congenital cardiac disease also a contraindication, but case-by-case discussion is needed. | |||||
| Timing of repair: patients who can be decannulated or weaned off ECLS may benefit from delaying repair until decannulation, but risk of delayed salvage repair on ECLS exists; patients with severe phenotype may benefit from early repair on ECLS | |||||
| Other topical recommendations provided: risk stratification, early postnatal care, management of pulmonary hypertension, mode of support, cannulation, pump time, on-ECLS ventilation strategies |
CDH, congenital diaphragmatic hernia; ECLS, extracorporeal life support; ELSO, extracorporeal life support organization; VA, veno-arterial; VV, veno-venous.