title: Ex utero intrapartum treatment with extracorporeal membrane oxygenation for severe congenital diaphragmatic hernia.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Shaun M
authors.initials: SM
authors.lastname: Kunisaki
authors.forename: Carol E
authors.initials: CE
authors.lastname: Barnewolt
authors.forename: Judy A
authors.initials: JA
authors.lastname: Estroff
authors.forename: Laura B
authors.initials: LB
authors.lastname: Myers
authors.forename: Dario O
authors.initials: DO
authors.lastname: Fauza
authors.forename: Louise E
authors.initials: LE
authors.lastname: Wilkins-Haug
authors.forename: Ian A
authors.initials: IA
authors.lastname: Grable
authors.forename: Steven A
authors.initials: SA
authors.lastname: Ringer
authors.forename: Carol B
authors.initials: CB
authors.lastname: Benson
authors.forename: Luanne P
authors.initials: LP
authors.lastname: Nemes
authors.forename: Donna
authors.initials: D
authors.lastname: Morash
authors.forename: Terry L
authors.initials: TL
authors.lastname: Buchmiller
authors.forename: Jay M
authors.initials: JM
authors.lastname: Wilson
authors.forename: Russell W
authors.initials: RW
authors.lastname: Jennings
mesh_terms: D000328:Adult; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D046128:Fetal Therapies / Q000379:methods*; D006548:Hernia, Diaphragmatic / Q000175:diagnosis / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D011296:Prenatal Diagnosis; D012121:Respiration, Artificial; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome