title: A Modified EXIT-to-ECMO with Optional Reservoir Circuit for Use during an EXIT Procedure Requiring Thoracic Surgery.
abstract: A 34 year old mother with a history of polyhydraminos and premature rupture of membranes presented for an ex utero intrapartum treatment (EXIT) procedure to deliver her 34 week gestation fetus. The fetus had been diagnosed with a large cervical mass which significantly extended into the right chest. The mass compressed and deviated the airway and major neck vessels posteriorly. Imaging also revealed possible tumor involvement with the superior vena cava and right atrium. The plan was for potential extracorporeal membrane oxygenation (ECMO) during the EXIT procedure (EXIT-to-ECMO) and the potential for traditional cardiopulmonary bypass (CPB) for mediastinal tumor resection. A Modified EXIT-To-ECMO with Optional Reservoir (METEOR) circuit was devised to satisfy both therapies. A fetal airway could not be established during the EXIT procedure and so the EXIT-to-ECMO strategy was utilized. The fetus was then delivered and transferred to an adjoining operating room (OR). Traditional cardiopulmonary bypass with a cardiotomy venous reservoir (CVR) was utilized during the establishment of an airway, tumor biopsy and partial resection. The patient was eventually transitioned to our institution's standard ECMO circuit and then transferred to the intensive care unit. The patient was weaned from ECMO on day of life (DOL) eight and had a successful tumor resection on DOL 11. The patient required hospitalization for numerous interventions including cardiac surgery at 4 months of age. She was discharged to home at 5 months of age.
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Matte
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Connor
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Nathalia A
authors.initials: NA
authors.lastname: Toutenel
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Danielle
authors.initials: D
authors.lastname: Gottlieb
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Francis
authors.initials: F
authors.lastname: Fynn-Thompson
mesh_terms: D001011:Aorta / Q000002:abnormalities / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000379:methods; D002585:Cesarean Section / Q000379:methods*; D003131:Combined Modality Therapy; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications / Q000151:congenital / Q000601:surgery*; D006330:Heart Defects, Congenital / Q000150:complications / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000601:surgery; D036801:Parturition; D011247:Pregnancy; D013724:Teratoma / Q000150:complications / Q000151:congenital / Q000601:surgery*; D019616:Thoracic Surgical Procedures / Q000379:methods*
keywords: CPB; ECMO; METEOR circuit; cardiopulmonary bypass; cervical teratoma; ex utero intrapartum treatment (EXIT) procedure; extracorporeal membrane oxygenation; hybrid bypass circuit