Combined extracorporeal membrane oxygenation support and patent ductus arteriosus ligation following surgical correction for congenital diaphragmatic hernia, a case report and literature review

Abstract Background: Therapeutic measures regarding combined extracorporeal membrane oxygenation support and arterial ductus arteriosus ligation after surgical correction of congenital diaphragmatic hernia are rare in clinical practice. Case presentation: In this case, the patient was diagnosed at 24 weeks with a right-sided diaphragmatic hernia. He was the firstborn, delivered at 37 weeks via cesarean section due to fetal distress. Due to severe hypoxemia and pulmonary hypertension, the patient underwent right-sided thoracic diaphragmatic hernia repair surgery at 22 hours post-birth. Perioperatively, the patient exhibited severe respiratory and circulatory failure. Consequently, ECMO support was initiated one hour after the surgery (24 hours post-birth). Due to the high left to right shunt, bedside patent arterial duct ligation was successfully performed under ECMO support four hours later (28 hours post-birth). During the second day on ECMO, the patient developed intracranial hemorrhage, leading to the performance of a lateral ventriculostomy. Fortunately, the patient was successfully weaned off ECMO. Conclusions: Treatment strategies for CDH must be tailored to each patient’s unique clinical situation, encompassing aspects such as ventilation tactics, surgical timing, anesthesia choices, and surgical techniques. The detailed analysis of this case in this report illustrates the critical importance of tailoring CDH management to optimize patient prognosis.