**9. Extracorporeal membrane oxygenation**

Congenital diaphragmatic hernia is the most common non-cardiac indication for extracorporeal membrane oxygenation in the neonates, even though the benefits of the intervention in terms of mortality in CDH are questionable. A retrospective study of the extracorporeal life support organization (ECLS) registry data revealed the overall survival of 48.1% in term neonates representing a 13.8% reduction in survival of neonates with CDH who were treated with ECMO [193]. This result probably represents the fact that more serious CDH cases were subjected to ECMO [194]. CDHSG registry data, on the other hand, have documented an improved survival in the most severely affected CDH patients with ECMO [195]. The recently published VICI trial [136] failed to demonstrate any difference in CDH outcomes between ECLS and non-ECLS centers, further questioning the role of ECMO in CDH. The indication and utility of ECMO in CDH is still evolving, as is the timing of surgery. It should be discussed during prenatal counselling and may be considered as a therapeutic option in those centers that offer it.
