Extracorporeal membrane oxygenation in patients with congenital diaphragmatic hernia.

Since the introduction of extracorporeal membrane oxygenation (ECMO) support for neonatal respiratory failure, the use of ECMO for infants with congenital diaphragmatic hernia has increased significantly. ECMO is offered to infants with a high risk of dying (with reported survival rates of 38% to 65%). Unstable infants can be placed on ECMO with subsequent repair on ECMO or after weaning from support. The complication rate can be high with repair on ECMO, but changes in operative techniques have decreased the risk. Most centers use venoarterial ECMO in patients with congenital diaphragmatic hernia (CDH), but venovenous ECMO appears as effective. ECMO support appears to have improved the survival rate in high-risk infants with CDH, but because almost all studies are retrospective single institutional and have small numbers of patients, the true improvement in survival rate is difficult to quantitate. Further studies of the value of ECMO in patients with CDH are warranted.