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

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)420-425
Number of pages6
JournalJournal of pediatric surgery
Volume42
Issue number2
DOIs
StatePublished - Feb 1 2007
Externally publishedYes

Keywords

  • Bronchogenic cyst
  • Congenital cystic adenomatoid malformation
  • ECMO
  • EXIT
  • Ex utero intrapartum treatment
  • Extracorporeal membrane oxygenation
  • Fetus

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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  • Cite this

    Kunisaki, S. M., Fauza, D. O., Barnewolt, C. E., Estroff, J. A., Myers, L. B., Bulich, L. A., Wong, G., Levine, D., Wilkins-Haug, L. E., Benson, C. B., & Jennings, R. W. (2007). Ex utero intrapartum treatment with placement on extracorporeal membrane oxygenation for fetal thoracic masses. Journal of pediatric surgery, 42(2), 420-425. https://doi.org/10.1016/j.jpedsurg.2006.10.035