Key Highlights:
VV vs VA ECMO: While venovenous (VV) ECMO is gaining traction with improved cannulas, venoarterial (VA) ECMO remains the predominant choice for most centers treating CDH.
When to initiate ECMO: Early intervention is often favored in high-risk CDH cases, especially when prenatal imaging suggests severe compromise.
SPHERE protocol in decision-making: A structured approach from Michigan offers criteria for ECMO vs comfort care, but outcome prediction remains unreliable—50% of decisions based on early data may be incorrect.
Controversy in selection: Dr. Stark advocates for offering ECMO to all infants with isolated unilateral CDH, emphasizing the importance of treating every case as a potential survivor.
Role of prenatal counseling: Early, transparent discussions with families are critical for navigating high-stakes decisions and aligning on care pathways.
This session underscores both the technical and ethical complexity in managing severe CDH—and the need for thoughtful protocols paired with clinical flexibility.
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