Congenital diaphragmatic hernia and complete tracheal rings: The value of peri-operative ECMO

A full-term male prenatally diagnosed with left congenital diaphragmatic hernia (CDH) was intubated at birth and scheduled for elective repair. The pre-operative chest radiograph incidentally demonstrated tracheal narrowing and an intraoperative flexible bronchoscopy was performed, suggestive of impending airway occlusion secondary to complete tracheal rings. Given these findings, he was electively cannulated post-operatively to venoarterial extracorporeal membrane oxygenation (ECMO) for stabilization and tracheal repair. Post-operative day one, he underwent further characterization by computed tomography and was taken for slide tracheoplasty on ECMO support. Immediately following tracheal repair, he was decannulated from ECMO and was extubated to nasal CPAP two days after the slide tracheoplasty. This case highlights the rare association of tracheal anomalies associated with CDH and options for perioperative management, including the role of ECMO.