Infographic: Comparison of prenatal lung volume measurements associated with extracorporeal membrane oxygenation (ECMO) utilization and mortality in congenital diaphragmatic hernia

Infographic · May 2026 · 1 min read

In brief

Comparative analysis of prenatal lung volume measurements for predicting ECMO need and mortality in CDH. Study identifies percent predicted lung volume (PPLV) at late gestation as the strongest single predictor, with O/E total fetal lung volume showing consistent accuracy across both early and late timepoints.

Written by the GCMD Library team from the infographic.

A three-column comparison layout with illustrated diagrams of surgical procedures. Each column contains a procedural illustration at the top, followed by statistical data presented in colored text blocks. The left column uses blue accents, the middle uses green, and the right uses purple. Bar charts or percentage indicators appear below each procedure illustration.

Philip Stanic, Amelia Gavulic, Todd M Jenkins, Colton Brown, Jason Frischer, Beth Rymeski, Foong-Yen Lim, Laura Galganski

Background: Prenatal imaging plays a central role in risk stratification for congenital diaphragmatic hernia (CDH). We sought to identify the most accurate predictor of mortality and ECMO utilization at early and late gestation timepoints amongst the various lung volume measurements: lung-to-head ratio (LHR), observed-to-expected (O/E) LHR, O/E total fetal lung volume (TFLV) and percent predicted lung volume (PPLV).

Methods: Retrospective cohort study of patients with isolated left and right-sided CDH at our fetal care center from 2012 to 2023. Early gestation imaging was performed at initial evaluation (median 24.6 weeks) and late gestation imaging between 32 and 34 weeks gestation. Receiver-operating characteristic (ROC) curve analysis was performed to establish optimal lung measurement cutoff values (Youden's index) associated with ECMO utilization and mortality.

Results: For left CDH, late PPLV ≤17.6 % was the strongest predictor of ECMO utilization (AUC 0.93), while late PPLV ≤18.0 % was the strongest predictor of mortality (AUC 0.86). Early and late O/E TFLV were also strong predictors of both ECMO utilization (AUC 0.86) and mortality (AUC 0.80-0.82). For right CDH, late PPLV ≤16.4 % was the strongest predictor of ECMO utilization (AUC 0.96), whereas late O/E LHR ≤40.5 % was the strongest predictor of mortality (AUC 0.70). Other early lung metrics demonstrated moderate to poor predictive ability.

Conclusion: O/E TFLV is the best overall predictor of ECMO utilization and mortality in both early and late prenatal imaging. Late gestation PPLV is the best single predictor of ECMO utilization in left and right CDH and mortality in left CDH.

The text in the image