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Ex utero intrapartum treatment to extracorporeal membrane oxygenation: lifesaving management of a giant cervical teratoma

Published online by Cambridge University Press:  01 July 2020

N H Reeve ,
J B Kahane ,
A G Spinner  and
T J O-Lee
N H Reeve*
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, University of Nevada, Las Vegas School of Medicine, USA
J B Kahane
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, University of Nevada, Las Vegas School of Medicine, USA
A G Spinner
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, University of Nevada, Las Vegas School of Medicine, USA
T J O-Lee
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Loma Linda University School of Medicine, California, USA
*
Author for correspondence: Dr Nathaniel Reeve, Department of Otolaryngology – Head and Neck Surgery, University of Nevada, Las Vegas School of Medicine, 1701 W Charleston Blvd, Suite 490, Las Vegas, NV89102, USA E-mail: [email protected]
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Abstract

Background

Ex utero intrapartum treatment (‘EXIT’ procedure) is a well described method for maintaining maternal–fetal circulation in the setting of airway obstruction from compressive neck masses. When ex utero intrapartum treatment to airway is not feasible, ex utero intrapartum treatment to extracorporeal membrane oxygenation (‘ECMO’) has been described in fetal cardiopulmonary abnormalities.

Objective

This paper presents the case of a massively compressive midline neck teratoma managed with ex utero intrapartum treatment to extracorporeal membrane oxygenation, allowing for neonatal survival, with controlled airway management and subsequent resection.

Case report

A 34-year-old-female presented with a fetal magnetic resonance imaging scan demonstrating a 15 cm compressive midline neck teratoma. Concern for failure of ex utero intrapartum treatment to airway was high. The addition of the ex utero intrapartum treatment to extracorporeal membrane oxygenation procedure provided time for the planned subsequent resection of the mass and tracheostomy.

Conclusion

Ex utero intrapartum treatment procedures allow for securement of the difficult neonatal airway, while maintaining a supply of oxygenated blood to the newborn. Ex utero intrapartum treatment circulation lasts on average less than 30 minutes. The arrival of extracorporeal membrane oxygenation has enabled the survival of neonates with disease processes previously incompatible with life.

Keywords

Congenital AbnormalitiesExtracorporeal Membrane OxygenationTeratomaAirway ManagementTracheostomyNeonate
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 134 , Issue 7 , July 2020 , pp. 650 - 653
Copyright
Copyright © JLO (1984) Limited, 2020

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Footnotes

Dr N Reeve takes responsibility for the integrity of the content of the paper

Presented as a poster at the American Society of Pediatric Otolaryngology (‘ASPO’) Annual Meeting / Combined Otolaryngology Spring Meeting (‘COSM’), 3–5 May 2019, Austin, Texas, USA.

References

Wolter, NE, Siegele, B, Cunningham, MJ. Cystic cervical teratoma: a diagnostic and management challenge. Int J Pediatr Otorhinolaryngol 2017;95:97–100CrossRefGoogle ScholarPubMed
Laje, P, Johnson, MP, Howell, LJ, Bebbington, MW, Hedrick, HL, Flake, AW et al. Ex utero intrapartum treatment in the management of giant cervical teratomas. J Pediatr Surg 2012;47:1208–16CrossRefGoogle ScholarPubMed
Mychaliska, GB, Bealer, JF, Graf, JL, Rosen, MA, Adzick, NS, Harrison, MR. Operating on placental support: the ex utero intrapartum treatment procedure. J Pediatr Surg 1997;32:227–30CrossRefGoogle ScholarPubMed
Liechty, KW, Crombleholme, TM, Flake, AW, Morgan, MA, Kurth, CD, Hubbard, AM et al. Intrapartum airway management for giant fetal neck masses: the EXIT (ex utero intrapartum treatment) procedure. Am J Obstet Gynecol 1997;177:870–4Google ScholarPubMed
Michel, TC, Rosenberg, AL, Polley, LS. EXIT to ECMO. Anesthesiology 2002;91:267–8CrossRefGoogle Scholar
Kunisaki, SM, Fauza, DO, Barnewolt, CE, Estroff, JA, Myers, LB, Bulich, LA et al. Ex utero intrapartum treatment with placement on extracorporeal membrane oxygenation for fetal thoracic masses. J Pediatr Surg 2007;42:420–5CrossRefGoogle ScholarPubMed
Mychaliska, GB, Bryner, BS, Nugent, C, Barks, J, Hirschl, RB, McCrudden, K et al. Giant pulmonary sequestration: the rare case requiring the EXIT procedure with resection and ECMO. Fetal Diagn Ther 2009;25:163–6Google ScholarPubMed
Shieh, HF, Wilson, JM, Sheils, CA, Smithers, CJ, Kharasch, VS, Becker, RE et al. Does the ex utero intrapartum treatment to extracorporeal membrane oxygenation procedure change morbidity outcomes for high-risk congenital diaphragmatic hernia survivors? J Pediatr Surg 2017;52:22–5CrossRefGoogle ScholarPubMed
Matte, GS, Connor, KR, Toutenel, NA, Gottlieb, D, Fynn-Thompson, F. A modified EXIT-to-ECMO with optional reservoir circuit for use during an EXIT procedure requiring thoracic surgery. J Extra Corpor Technol 2016;48:35–8Google ScholarPubMed
Marwan, A, Crombleholme, TM. The EXIT procedure: principles, pitfalls and progress. Semin Pediatr Surg 2006;15:107–15CrossRefGoogle ScholarPubMed
Liechty, KW, Hedrick, HL, Hubbard, AM, Johnson, MP, Wilson, RD, Ruchelli, ED et al. Severe pulmonary hypoplasia associated with giant cervical teratomas. J Pediatr Surg 2006;41:230–3CrossRefGoogle ScholarPubMed