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

This retrospective study compared four prenatal lung volume measurements to predict ECMO need and mortality in CDH patients. Late-gestation percent predicted lung volume (PPLV) emerged as the strongest single predictor, while observed-to-expected total fetal lung volume showed consistent accuracy across both early and late imaging timepoints.

Late gestation PPLV ≤17-18% is the strongest single predictor of ECMO need and mortality in left-sided CDH (AUC 0.86-0.93).
O/E TFLV demonstrates consistent predictive accuracy across both early and late gestation for ECMO utilization and mortality in CDH.
Right-sided CDH shows different optimal thresholds: late PPLV ≤16.4% predicts ECMO need, while O/E LHR ≤40.5% predicts mortality.
Late gestation imaging (32-34 weeks) provides superior prognostic accuracy compared to early gestation measurements for CDH outcomes.
Early prenatal lung metrics show only moderate-to-poor predictive ability; defer definitive risk stratification to third trimester imaging.

Written by the GCMD Library team from the infographic.

The infographic uses a teal, coral, and yellow color scheme with icons including a clock, fetus illustration, and lung diagram. The layout flows from top to bottom with the study details at top, research question in middle, two measurement methods highlighted in colored boxes, and conclusion at bottom. Medical illustrations support each section.

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

Comparison of Prenatal Lung Volume Measurements Associated w/ ECMO Utilization & Mortality in Congenital Diaphragmatic Hernia (CDH) | Retrospective Cohort Study | 2012-2023 | 132 patients | w/ isolated left and right-sided CDH | early gestation imaging: median of 24.6 weeks | late gestation imaging: median of 32-34 weeks | What is the best way to predict mortality and ECMO utilization for patients with CDH? | Observed-to-Expected Total Fetal Lung Volume (O/E TFLV) | BEST overall predictor of ECMO need & mortality in both early and late prenatal imaging | Percent Predicted Lung Volume (PPLV) | best single imaging predictor of ECMO need and mortality in left CDH, and ECMO use in right CDH | Measuring O/E TFLV and PPLV guides counseling, delivery planning, and ECMO preparedness | Conclusion: | MRI-based lung volume measurements improve risk stratification. PPLV is the single best prenatal predictor of ECMO utilization in CDH, suggesting that a 3rd trimester MRI adds critical prognostic information. | https://pubmed.ncbi.nlm.nih.gov/41619847/ | Stanic P et. al. | University of Cincinnati College of Medicine, Cincinnati, United States | @LizzyPAC8 | @globalcastmd | @StayCurrentMD | Cincinnati Children's