Anaesthetic management of patients with a congenital diaphragmatic hernia

A congenital diaphragmatic hernia (CDH) occurs when a defect in the diaphragm allows abdominal organs to protrude into the thoracic cavity (Fig. 1). It affects approximately 1 in 3600 registered births(1) and is a potentially life-threatening condition, the severity of which is primarily related to the extent of lung hypoplasia and pulmonary hypertension. Advances in management strategies include protective ventilation, careful timing of surgery, the judicious use of extracorporeal membrane oxygenation (ECMO) and the introduction of both thoracoscopic and fetal intervention, but it remains a challenging condition to treat successfully with overall mortality rates still around 30%.