The Management of Congenital Diaphragmatic Hernia in Infants with Extracorporeal Membrane Oxygenation: A Systematic Review

Congenital Diaphragmatic Hernia (CDH) is a rare birth defect in which the diaphragm fails to close during prenatal development, which causes the intestinal contents to herniate into the chest from the abdominal cavity causing lung hypoplasia and persistent pulmonary hypertension of the newborn (PPHN). Extracorporeal membrane oxygenation (ECMO) is a rescue therapy for infants having CDH on whom the conventional ventilation strategies fail. Our systematic review aimed to evaluate the outcomes of Extracorporeal Membrane Oxygenation (ECMO) use on infants with Congenital Diaphragmatic Hernia (CDH). We used PubMed, Embase, Web of Science and Google Scholars databases for our data collection, and articles from 2010-2021 were analyzed and included as part of this research. We included studies in the English language conducted on human infants. We excluded studies conducted before 2010, studies on animals, languages other than English, or studies conducted on the adult population from our research. We identified a total of 3650 studies from the databases. After removing duplicates, screening titles, applying inclusion-exclusion criteria, and assessing the papers' quality, we were left with nine articles. Six out of these nine articles were retrospective cohort studies, and three were literature reviews. We extracted data manually from these studies. ECMO's role in managing CDH in infants is controversial as some studies show improvements in infants' survival rate. In contrast, other studies mention that the risks involved in ECMO use outweigh the benefits, and we should only use it in those infants who are severely affected. Due to inadequate data, we require additional research to determine whether the use of ECMO is favorable or should it be discouraged.