Congenital diaphragmatic hernia (CDH) is characterized by malformation of the diaphragm, allowing for herniation of abdominal contents into the thoracic cavity. The most significant sequelae of this herniation are pulmonary hypoplasia and pulmonary hypertension, both contributing to significant morbidity and mortality. Multiple strategies exist to minimize respiratory compromise and improve outcome in a patient with CDH, including fetal intervention in selective cases, medical and pharmaceutical management, advanced ventilation strategies, extracorporeal membrane oxygenation (ECMO), and complete surgical repair. Veno-arterial ECMO (circuit between the internal jugular vein and the carotid artery) is used in infants who are unstable and require aggressive cardiopulmonary support, and veno-venous ECMO (circuit with a double lumen catheter in the internal jugular vein) is used in infants who only need respiratory support.
