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same-site approach in two previously reported cases that required re-cannulation years after the initial ECMO run [ 7 ]. Dela Cruz et al. [ 7 ] have proposed that initial cannulation should be performed in the midsection of the neck to provide adequate proximal vessel length in case re-cannulation becomes necessary. Cannulating the contralateral neck would have led to occlusion of both carotid arteries and jugular veins, potentially compromising arterial brain perfusion and venous return. In our case, femoral vessel cannulation was not possible due to the patient’ s size, the risk of ipsilateral limb ischemia, and the risk of“ north-south” syndrome. Therefore, we chose central cannulation via the aorta and right atrium. In addition to the anatomical considerations, central ECMO cannulation appeared to be an appropriate alternative, as it has been shown to improve survival in children with refractory septic shock [ 8 ].
While multiple courses of ECMO may provide potential survival benefits, these advantages must be balanced against the increased risk of complications. Survivors of congenital diaphragmatic hernia( CDH) who require repeat ECMO cannulation face the highest rates of morbidity [ 3 ]. In our case, we saw several short- and long-term complications, including substantial respiratory and gastrointestinal problems. We also observed significant neuroimaging abnormalities and severe neurodevelopmental impairments. Given that both prematurity and ECMO use are linked to adverse neurological outcomes in CDH [ 9, 10 ], it remains uncertain whether the increased risk of multisystem morbidities stems from the severity of the disease necessitating repeat ECMO, the treatment itself, or a combination of both factors. These morbidities, however, should not necessarily prevent repeat ECMO use but rather guide the discussions with families and emphasize the importance of close follow-up for these patients.
Our patient recovered from an acute exacerbation of pulmonary hypertension, demonstrating that repeat ECMO is not futile in this clinical scenario. Successful recannulation requires multidisciplinary discussions and excellent collaboration and coordination among medical and surgical teams. However, due to the lack of selection criteria and the high likelihood of increased multisystem morbidities, this intensified approach should be highly individualized.
Funding The authors received no funding to complete this research.
Conflicts of interest The authors declare no conflict of interest.
Data availability statement
The data supporting this study’ s findings are available from the corresponding author upon reasonable request.
Author contribution statement
ED, SJF, HLH, and NER, contributed substantially to the case report conception and design, acquisition, analysis, and interpretation of data. GLB and JMC contributed significantly to data acquisition, analysis, and interpretation. ED drafted the manuscript, while all authors performed critical revisions for important intellectual content. All authors agreed upon and approved the final version of this manuscript.
Ethics approval
The Institutional Review Board at the Children’ s Hospital of Philadelphia approved the current study, and all parents or legal guardians gave written or verbal informed consent for their children to be included in our database( IRB 18-015396).
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Cite this article as: Danzer E, Flohr SJ, Hedrick HL, Bird GL, Chen JM & Rintoul NE. Indication, technical considerations, and outcome of remote central cannulation for repeat extracorporeal membrane oxygenation in congenital diaphragmatic hernia: a case report. J Extra Corpor Technol 2025, 57, 168--170. https:// doi. org / 10.1051 / ject / 2025019.