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Ex utero intrapartum treatment with placement on extracorporeal membrane oxygenation for fetal thoracic masses |
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| Authors: | Kunisaki Shaun M Fauza Dario O Barnewolt Carol E Estroff Judy A Myers Laura B Bulich Linda A Wong Geoffrey Levine Deborah Wilkins-Haug Louise E Benson Carol B Jennings Russell W |
| Institution: | a Department of Surgery, Children's Hospital Boston, Boston, MA, USA b Advanced Fetal Care Center, Children's Hospital Boston, Boston, MA, USA c Department of Radiology, Children's Hospital Boston, Boston, MA, USA d Department of Anesthesia, Children's Hospital Boston, Boston, MA, USA e Department of Obstetrics and Gynecology, Beth-Israel Deaconess Medical Center, Boston, MA, USA f Department of Radiology, Beth-Israel Deaconess Medical Center, Boston, MA, USA g Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA h Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA |
| Abstract: | PurposeWe 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).MethodsThe 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.ResultsIn 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.ConclusionTo 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. |
| Keywords: | Ex utero intrapartum treatment EXIT Extracorporeal membrane oxygenation ECMO Fetus Congenital cystic adenomatoid malformation Bronchogenic cyst |
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