Ex utero intrapartum treatment with placement on extracorporeal membrane oxygenation for fetal thoracic masses

Shaun M Kunisaki, Dario O Fauza, Carol E Barnewolt, Judy A Estroff, Laura B Myers, Linda A Bulich, Geoffrey Wong, Deborah Levine, Louise E Wilkins-Haug, Carol B Benson, Russell W Jennings
Journal of Pediatric Surgery 2007, 42 (2): 420-5

PURPOSE: We describe our experience with fetuses diagnosed with life-threatening chest masses who were delivered by ex utero intrapartum treatment with placement on extracorporeal membrane oxygenation (EXIT-to-ECMO).

METHODS: The first fetus presented with a cystic mediastinal mass and enlarging echogenic lungs. Bronchoscopic evaluation during ex utero intrapartum treatment (EXIT) revealed complete airway obstruction secondary to a carinal bronchogenic cyst. The second fetus presented with a massive left congenital cystic adenomatoid malformation. The EXIT procedure was performed because of significant mediastinal shift, severe compression of the normal lung parenchyma, and signs of fetal distress.

RESULTS: In both cases, extracorporeal membrane oxygenation (ECMO) was initiated while on placental support. The fetuses were then delivered, and a definitive resection of their thoracic lesions was successfully performed. There were no major perioperative complications. Both children made expedient recoveries without significant cardiopulmonary sequelae.

CONCLUSION: To our knowledge, this is the first report describing the successful use of EXIT-to-ECMO as a bridge to definitive resection of large chest masses diagnosed in utero. EXIT-to-ECMO is a novel and effective management strategy for stabilizing patients with profound respiratory compromise secondary to congenital thoracic lesions.

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