Ex utero intrapartum treatment with extracorporeal membrane oxygenation for severe congenital diaphragmatic hernia.
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.
Kunisaki
Shaun M
SM
Department of Surgery, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA.
Barnewolt
Carol E
CE
Estroff
Judy A
JA
Myers
Laura B
LB
Fauza
Dario O
DO
Wilkins-Haug
Louise E
LE
Grable
Ian A
IA
Ringer
Steven A
SA
Benson
Carol B
CB
Nemes
Luanne P
LP
Morash
Donna
D
Buchmiller
Terry L
TL
Wilson
Jay M
JM
Jennings
Russell W
RW
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