Extracorporeal membrane oxygenation as a bridge to definitive tracheal reconstruction in neonates.
OBJECTIVE
Infants born with severe tracheal anomalies may not survive beyond the first few hours of life without aggressive cardiopulmonary support and/or emergent airway surgery. The purpose of this study was to review our experience with critically ill neonates supported on extracorporeal membrane oxygenation (ECMO) before tracheal reconstruction.


METHODS
A retrospective review of a single institution ECMO registry was conducted. Outcomes of neonates requiring tracheal repair were examined.


RESULTS
Three children with tracheal anomalies (complete tracheal rings [n = 2]; bronchogenic cyst [n = 1]) underwent definitive airway reconstruction. All were placed on ECMO (venovenous [n = 2]; venoarterial [n = 1]) within 24 hours after birth. Tracheoplasties (tracheal resection with end-to-end anastomosis [n = 1]; slide tracheoplasty [n = 1]; carinal resection and reconstruction [n = 1]) were performed at 3.7 +/- 2.2 days of life. There were no hemorrhagic or thrombotic complications for an ECMO time of 117.3 +/- 60.1 hours. The postoperative durations until extubation and hospital discharge were 12.0 +/- 3.2 and 34.3 +/- 11.6 days, respectively. All children remain alive and well without cardiopulmonary and neurologic sequelae at a mean follow-up of 4.5 years.


CONCLUSIONS
Excellent clinical outcomes can be achieved in neonates born with severe tracheal anomalies using ECMO as a bridge to definitive tracheal reconstruction.
Kunisaki
Shaun M
SM
Department of Surgery, Children's Hospital Boston, Boston, MA 02115, USA. skunisaki@partners.org
Fauza
Dario O
DO
Craig
Nancy
N
Jennings
Russell W
RW
D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D014132:Trachea / Q000002:abnormalities* / Q000601:surgery*; D014135:Tracheal Stenosis / Q000151:congenital* / Q000601:surgery*; D016896:Treatment Outcome