Case Report

Indication, technical considerations, and outcome of remote central cannulation for repeat extracorporeal membrane oxygenation in congenital diaphragmatic hernia: a case report

¹ The Richard Wood Jr. Center for Fetal Diagnosis and Treatment, The Children’s Hospital of Philadelphia, 5th Floor Wood Center, The Children’s Hospital of Philadelphia, 3615 Civic Center Blvd, Philadelphia, PA, 19104-4318, USA
² Division of Critical Care, Department of Anesthesiology and Critical Care Medicine, Cardiac Center at the Children’s Hospital of Philadelphia, Division of Cardiology, Department of Pediatrics, Cardiac Center at the Children’s Hospital of Philadelphia, 3615 Civic Center Blvd, Philadelphia, PA, 19104-4318, USA
³ Division of Cardiothoracic Surgery, Cardiac Center at the Children’s Hospital of Philadelphia, 3615 Civic Center Blvd, Philadelphia, PA, 19104-4318, USA

^* Corresponding author: danzere@chop.edu

Received: 4 January 2025
Accepted: 28 April 2025

Abstract

Repeat extracorporeal membrane oxygenation (ECMO) is rare in children with congenital diaphragmatic hernia (CDH). Improving our understanding of the potential survival benefits, complications, and surgical challenges associated with this procedure is essential for enhancing decision-making regarding multicourse ECMO in CDH. We report the case of a now 3-year-old girl who required cannulation through median sternotomy 5 months after her initial neonatal ECMO treatment via cervical venoarterial cannulation. This second run of ECMO was performed due to an acute exacerbation of pulmonary hypertension caused by urosepsis. This case illustrates that repeat ECMO should be considered for selected CDH patients when a reversible cause for clinical deterioration is identified. We also emphasize the importance of interdisciplinary decision-making, considering alternative cannulation methods, and providing appropriate family counseling. It is crucial to balance the potential survival benefits of repeat ECMO against the increased risks of morbidity.