Background: Successful treatment with multiple damage-control surgeries and extracorporeal membrane oxygenation is rare. Case Presentation: We report a case of defibrillation-resistant ventricular fibrillation in a 35-year-old man. Veno-arterial extracorporeal membrane oxygenation was initiated immediately, during which left external iliac vein injury occurred, and emergency surgery was performed thereafter. Laparotomy revealed left external iliac vein injury with massive intra-abdominal hemorrhage, and the vascular injury was repaired. However, the patient developed abdominal compartment syndrome, necessitating damage control surgery with open abdominal management. Multiple subsequent surgeries were performed, and abdominal closure was performed on day five. The patient was discharged with complete neurological recovery on day 73. Conclusion: Damage control surgery under extracorporeal membrane oxygenation carries the concern of hemorrhagic complications, necessitating careful consideration of its indications. However, this approach remains viable for the treatment of patients with defibrillation-resistant ventricular fibrillation.
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