J Extra Corpor Technol 2025, 57, 168--170 Ó The Author( s), published by EDP Sciences, 2025 https:// doi. org / 10.1051 / ject / 2025019
Available online at: ject. edpsciences. org
CASE REPORT
Indication, technical considerations, and outcome of remote central cannulation for repeat extracorporeal membrane oxygenation in congenital diaphragmatic hernia: a case report Enrico Danzer( MD) 1,*, Sabrina J. Flohr( MPH) 1, Holly L. Hedrick( MD) 1, Geoffrey L. Bird( MD) 2, Jonathan M. Chen( MD) 3, and Natalie E. Rintoul( MD) 1
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 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.
Key words: Congenital diaphragmatic hernia, Extracorporeal membrane oxygenation( ECMO), Central cannulation, Multicourse ECMO, Pulmonary hypertension.
Introduction
Neonates with congenital diaphragmatic hernia( CDH) complicated by severe pulmonary hypoplasia, pulmonary hypertension, and cardiac dysfunction may require extracorporeal membrane oxygenation( ECMO) to support them through the initial cardiorespiratory transition and to provide an opportunity for surgical repair [ 1, 2 ]. While approximately one-third of newborns with CDH receive ECMO as a life-sustaining intervention in the neonatal period, the utilization of multicourse ECMO in this population is rare [ 3 ]. Therefore, data on recannulation needs and outcomes are scarce, limiting our understanding of the effects of multicourse ECMO on neonates with CDH.
Herein, we report a case of a now 3-year-old female who required repeat cannulation via a median sternotomy 5 months after the initial neonatal ECMO cervical venoarterial run due to
* Corresponding author: danzere @ chop. edu an acute exacerbation of pulmonary hypertension secondary to urosepsis. This case demonstrates that repeat ECMO represents a potential management strategy for selected CDH patients in which a reversible cause for clinical deterioration can be identified. We also highlight the interdisciplinary decision-making process, the importance of considering alternative cannulation approaches, and the need for appropriate family counseling, as the potential survival benefits of repeat ECMO must be balanced against the increased risks of morbidities.
Case report
This case involves a now 3-year-old African American female who was diagnosed with a left-sided congenital diaphragmatic hernia( CDH) at 21 weeks and 2 days of gestation. At that time, her observed-to-expected lung head ratio( O / E LHR) was 25.1 %( using the trace method), and her observed-to-expected total lung volume( O / E TLV) was
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