The Ex Utero Intrapartum Treatment Procedure

Looking Back at the EXIT

Shinjiro Hirose, Diana L Farmer, Hanmin Lee, Kerilyn K. Nobuhara, Michael R. Harrison, R. P. Altman, M. Schwartz, T. Tracy, D. Cass

Research output: Contribution to journalArticle

129 Citations (Scopus)

Abstract

Purpose: The ex utero intrapartum treatment (EXIT) procedure was developed originally for management of airway obstruction after fetal surgery, and indications have continued to expand for a variety of fetal anomalies. The authors review their single-institution experience with EXIT. Methods: Retrospective review of all patients who underwent an EXIT procedure from 1993 to 2003 (n = 52) was performed. Variables evaluated include indication for EXIT, gender, gestational age at EXIT, birth weight, maternal blood loss, operative complications, operative time, and survival rate. Technique, personnel, and anesthesic management were reviewed. Results: Long-term follow-up was available for all patients. Fifty-one of 52 patients were born alive; currently, 27 of 52 patients (52%) are alive. All deaths have been in patients with congenital diaphragmatic hernia. Forty-five patients underwent EXIT for reversal of tracheal occlusion for congenital diaphragmatic hernia. Of these patients, 30 underwent tracheal clip removal. Two patients had repair of tracheal injury from clipping at EXIT. Fifteen patients underwent bronchoscopy and tracheal balloon removal. Five patients underwent EXIT procedure for neck masses. Tracheostomy was performed in 3 of these patients. One patient was intubated successfully, and 1 patient underwent resection of the neck mass while on placental support. Two patients underwent EXIT procedure and tracheostomy for congenital high-airway obstruction syndrome. Average gestational age at delivery was 31.95 ± 2.55 weeks. Average birth weight was 1,895 ± 653 g. Average maternal blood loss was 970 ± 510 mL. Average operating time on placental support was 45 ± 25 minutes with a maximum of 150 minutes. Conclusions: EXIT procedures can be performed with minimal maternal morbidity and with good outcomes. It is an excellent strategy for establishing an airway in a controlled manner, avoiding "crash" intubation or tracheostomy. Longer procedures on placental support allowing for definitive management of neck masses and airway obstruction have been realized. EXIT procedures have evolved from an adjunct to fetal surgery to a potentially life-saving procedure in fetuses with airway compromise at birth.

Original languageEnglish (US)
Pages (from-to)375-380
Number of pages6
JournalJournal of Pediatric Surgery
Volume39
Issue number3
DOIs
StatePublished - Mar 2004

Fingerprint

Therapeutics
Tracheostomy
Airway Obstruction
Neck
Mothers
Birth Weight
Gestational Age
Personnel Management
Bronchoscopy
Operative Time
Surgical Instruments
Intubation
Fetus
Survival Rate
Parturition
Morbidity
Wounds and Injuries
Congenital Diaphragmatic Hernias

Keywords

  • Airway management
  • Congenital diaphragmatic hernia
  • Congenital high airway obstruction syndrome
  • Ex utero intrapartum treatment procedure
  • Fetal airway
  • Fetal surgery
  • Fetal tracheostomy
  • Neck mass
  • Placental support

ASJC Scopus subject areas

  • Surgery

Cite this

The Ex Utero Intrapartum Treatment Procedure : Looking Back at the EXIT. / Hirose, Shinjiro; Farmer, Diana L; Lee, Hanmin; Nobuhara, Kerilyn K.; Harrison, Michael R.; Altman, R. P.; Schwartz, M.; Tracy, T.; Cass, D.

In: Journal of Pediatric Surgery, Vol. 39, No. 3, 03.2004, p. 375-380.

Research output: Contribution to journalArticle

Hirose, S, Farmer, DL, Lee, H, Nobuhara, KK, Harrison, MR, Altman, RP, Schwartz, M, Tracy, T & Cass, D 2004, 'The Ex Utero Intrapartum Treatment Procedure: Looking Back at the EXIT', Journal of Pediatric Surgery, vol. 39, no. 3, pp. 375-380. https://doi.org/10.1016/j.jpedsurg.2003.11.011
Hirose, Shinjiro ; Farmer, Diana L ; Lee, Hanmin ; Nobuhara, Kerilyn K. ; Harrison, Michael R. ; Altman, R. P. ; Schwartz, M. ; Tracy, T. ; Cass, D. / The Ex Utero Intrapartum Treatment Procedure : Looking Back at the EXIT. In: Journal of Pediatric Surgery. 2004 ; Vol. 39, No. 3. pp. 375-380.
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