PURPOSE: Optimal timing of congenital diaphragmatic hernia (CDH) repair in 
patients requiring extracorporeal membrane oxygenation (ECMO) remains 
controversial. The "late ECMO repair" is an approach where the patient, once 
deemed stable for decannulation, is repaired while still on ECMO to enable 
expeditious return to ECMO if surgery induces instability. The goal of this 
study was to investigate the potential benefit of this approach by evaluating 
the rate of return to ECMO after repair.
METHODS: The CDH Study Group database was used to analyze CDH patients requiring 
ECMO support. The primary outcome was return to ECMO within 72 h of CDH repair 
among those repaired following ECMO decannulation ("post-ECMO" patients). 
Secondary outcomes were death within 72 h of repair and cumulative death and 
return to ECMO rate.
RESULTS: A total of 668 patients were repaired post-ECMO decannulation. Six 
patients (0.9%) in the post-ECMO group required return to ECMO within 72 h of 
surgery and a total of 19 (2.8%) died or returned to ECMO within 72 h of 
surgery.
CONCLUSION: The rate of return to ECMO and death following CDH repair is 
extremely low and does not justify the risks inherent to "on-ECMO" repair. 
Patients stable to come off ECMO should undergo repair after decannulation.