Ex utero intrapartum treatment with placement on extracorporeal membrane oxygenation for fetal thoracic masses.
OBJECTIVE
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.


CONCLUSIONS
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.
Kunisaki
Shaun M
SM
Department of Surgery, Children's Hospital Boston, Boston, MA 02115, USA.
Fauza
Dario O
DO
Barnewolt
Carol E
CE
Estroff
Judy A
JA
Myers
Laura B
LB
Bulich
Linda A
LA
Wong
Geoffrey
G
Levine
Deborah
D
Wilkins-Haug
Louise E
LE
Benson
Carol B
CB
Jennings
Russell W
RW
D000328:Adult; D001999:Bronchoscopy; D002585:Cesarean Section; D015615:Cystic Adenomatoid Malformation of Lung, Congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D008423:Maternal Age; D011247:Pregnancy; D011256:Pregnancy Outcome; D018570:Risk Assessment; D012720:Severity of Illness Index; D013908:Thoracotomy / Q000379:methods*; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal