Ex utero intrapartum treatment with extracorporeal membrane oxygenation for severe congenital diaphragmatic hernia

Shaun M. Kunisaki, Carol E. Barnewolt, Judy A. Estroff, Laura B. Myers, Dario O. Fauza, Louise E. Wilkins-Haug, Ian A. Grable, Steven A. Ringer, Carol B. Benson, Luanne P. Nemes, Donna Morash, Terry L. Buchmiller, Jay M. Wilson, Russell W. Jennings

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: The purpose of this study was to determine whether ex utero intrapartum treatment with extracorporeal membrane oxygenation (EXIT to ECMO) is a reasonable approach for managing patients antenatally diagnosed with severe congenital diaphragmatic hernia (CDH). Methods: A 6-year retrospective review was performed on fetuses with severe CDH (liver herniation and a lung/head ratio <1.4, percentage of predicted lung volume <15, and/or congenital heart disease). Fourteen of the patients underwent EXIT with a trial of ventilation. Fetuses with poor preductal oxygen saturations despite mechanical ventilation received ECMO before their delivery. Maternal-fetal outcomes were analyzed. Results: There were no maternal-reported complications. Three babies passed the ventilation trial and survived, but 2 of them required ECMO within 48 hours. The remaining 11 fetuses received ECMO before their delivery. Overall survival after EXIT-to-ECMO was 64%. At 1-year follow-up, all survivors had weaned off supplemental oxygen, but 57% required diuretics and/or bronchodilators. Conclusion: This is the largest reported experience using EXIT to ECMO in the management of severe CDH. The EXIT-to-ECMO procedure is associated with favorable survival rates and acceptable pulmonary morbidity in fetuses expected to have a poor prognosis under conventional management.

Original languageEnglish (US)
Pages (from-to)98-106
Number of pages9
JournalJournal of pediatric surgery
Volume42
Issue number1
DOIs
StatePublished - Jan 2007
Externally publishedYes

Keywords

  • Congenital diaphragmatic hernia
  • Ex utero intrapartum treatment
  • Extracorporeal membrane oxygenation
  • Fetus

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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