Congenital Diaphragmatic Hernia Requiring ECMO: Current Evidence, Controversies, and Unresolved Questions

Background/Objectives: Congenital diaphragmatic hernia (CDH) requiring extracorporeal membrane oxygenation (ECMO) remains one of the most challenging conditions in neonatal critical care. Despite advances in prenatal assessment and neonatal management, substantial uncertainty persists regarding ECMO selection, mode and duration of support, and timing of diaphragmatic repair. This review summarizes the available evidence and critically examines the major unresolved questions in the management of infants with CDH requiring ECMO.

Methods

A narrative review was conducted based on a literature search in PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library for studies published between June 2005 and June 2026. Additional relevant publications were identified through reference screening, and selected foundational studies predating the search period were included when appropriate. Prospective and retrospective studies, registry-based analyses, systematic reviews, meta-analyses, and relevant consensus statements were considered. Evidence was narratively synthesized, with particular attention to disease severity, methodological limitations, and survivor bias.