Repair of a laryngotracheoesophageal cleft in an infant by means of extracorporeal membrane oxygenation.
Few survivors have been reported following attempted repair of laryngotracheoesophageal clefts (LTECs). The major challenge is maintaining oxygenation, both during the surgical repair and during the postoperative period of healing. We report a neonate with an LTEC extending to the carina whose successful repair was facilitated by extracorporeal membrane oxygenation (ECMO) begun intraoperatively and continued postoperatively for 11 days. The intraoperative surgical exposure of the defect was excellent. Postoperative trauma to the fresh tracheal repair from ventilatory pressures and endotracheal tube motion was eliminated through the use of ECMO. The patient was discharged without a tracheotomy and with a normal voice, cry, and swallow. According to this result, the use of ECMO may represent a significant advance in facilitating the correction of major laryngotracheoesophageal anomalies. The rationale, advantages, disadvantages, and potential pitfalls of this approach are presented, as well as preoperative and postoperative documentation of our results.
Geiduschek
J M
JM
Department of Anesthesiology, University of Washington School of Medicine, Seattle.
Inglis
A F
AF
O'Rourke
P P
PP
Kozak
F K
FK
Mayock
D E
DE
Sawin
R S
RS
D000013:Congenital Abnormalities / Q000601:surgery; D004947:Esophagus / Q000002:abnormalities* / Q000601:surgery; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007430:Intraoperative Care; D007830:Larynx / Q000002:abnormalities* / Q000601:surgery; D008722:Methods; D011182:Postoperative Care; D014132:Trachea / Q000002:abnormalities* / Q000601:surgery