Ex utero intrapartum treatment (EXIT) for fetal neck masses: A tertiary center experience and literature review

Jiang, Sydney; Yang, Catherina; Bent, John P.; Yang, Christina J.; Gangar, Mona; Nassar, Michel; Suskin, Barrie; Dar, P.

doi:10.1016/j.ijporl.2019.109642

Cited by 24 publications

(17 citation statements)

References 55 publications

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“…El principal principio del protocolo EXIT es mantener la circulación uteroplacentaria con anestesia neonatal, logrando una hipotonía uterina controlada. Esto permite asegurar la vía aérea fetal, descomprimir o resecar grandes masas cervicales o mediastínicas y servir como puente para proveer acceso vascular para ECMO (oxigenación por membrana extracorpórea), mejorando las posibilidades de supervivencia en estos casos [2][3][4][5][6][7][8] . La identificación antenatal de las lesiones congénitas potencialmente riesgosas de comprometer la vía aérea ha permitido mejorar los resultados permitiendo la coordinación especializada de la asistencia del parto 3 .…”

Section: Discussionunclassified

“…El adecuado acceso a cuidados prenatales es necesario para su diagnóstico 3,6 . Avances en ultrasonografía y resonancia nuclear magnética han llevado a una mejor delimitación de las lesiones 3,[5][6][7][8] . Las causas cervicales más frecuentes son los teratomas y malformaciones vasculares linfáticas y venosas 3,7 .…”

Section: Discussionunclassified

“…Fetos con potencial obstrucción de vía aérea neonatal, como los diagnosticados con masas cervicales congénitas, síndrome de obstrucción de vía aérea alta congénito (CHAOS por sus siglas en inglés) y micrognatia severa requieren de manejo especializado de la vía aérea al momento del parto 1 . Estas patologías han sido asociadas históricamente con pobres resultados, donde la asfixia y muerte perinatal eran frecuentes [2][3][4][5][6][7][8] . Esta obstrucción severa de vía aérea alta puede ocasionar graves consecuencias neurológicas por hipoxia o acidosis 4 .…”

Section: Introductionunclassified

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EXIT: Estado del arte y cómo lo hacemos

Alarcón¹,

Arancibia²,

Caballero³

et al. 2021

Rev. Otorrinolaringol. Cir. Cabeza Cuello

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Section: Discussionunclassified

Section: Introductionunclassified

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EXIT: Estado del arte y cómo lo hacemos

Alarcón¹,

Arancibia²,

Caballero³

et al. 2021

Rev. Otorrinolaringol. Cir. Cabeza Cuello

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“…Despite advances in imaging, the size or location of a mass alone does not predict an increased need for an airway intervention . Conversely, prenatal imaging that shows anatomic compression, solid mass, or polyhydramnios is linked with potential airway intervention …”

Section: Unique Considerations For Patients Requiring the Exit Proceduresmentioning

confidence: 99%

Airway management for neonates requiring ex utero intrapartum treatment (EXIT)

Mohammad

Olutoye

2020

Pediatric Anesthesia

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In utero congenital malformations in the fetus can occasionally lead to an obstructed airway at birth accompanied by hypoxic injury or peripartum demise, without intervention. Ex utero intrapartum treatment (EXIT) may help reduce morbidity and mortality associated with challenging airways by providing extra time on uteroplacental circulation to secure the airway. Meticulous preparation and planning are crucial for this procedure. Many different types of congenital malformations can result in a difficult airway, but there is no correlation between specific malformations and a required type of airway intervention. Based on our experience and literature review, an airway process flow diagram has been created to help assist teams in decision‐making for airway intervention in a neonate during the EXIT procedure. The management of the airway in this scenario involves additional unique considerations that accompany handling a partially delivered newborn in the uterine environment. Extensive preparation and team rehearsal are essential to the success of this procedure.

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“…2,14,16 A recent meta-analysis found that anatomic compression of the trachea and polyhydramnios emerged as correlates with need for airway intervention at birth. 17 The goal of this research was to identify prenatal imaging characteristics and clinical history that predict airway obstruction at birth and guide perinatal management decisions. All women referred for suspected abnormal fetal airway evaluation at our institution underwent systematic assessment within a multidisciplinary prenatal diagnosis clinic.…”

Section: Introductionmentioning

confidence: 99%

Prenatal Imaging Findings Predict Obstructive Fetal Airways Requiring EXIT

et al. 2020

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Objective: Detection of fetal airway compromise through imaging raises the possible need for ex utero intrapartum treatment (EXIT) procedures. Despite EXIT procedures involving massive resource utilization and posing increased risk to the mother, decisions for EXIT are usually based on anecdotal experience. Our objectives were to analyze prenatal consultations with potential fetal airway obstruction for imaging and obstetric findings used to determine management strategy. Methods: Retrospective chart review was performed for prenatal abnormal fetal airway consults between 2004-2019 at a quaternary pediatric facility. Data collected included demographics, imaging characteristics, delivery information, and airway management. Our primary outcome was EXIT performance and the secondary outcome was postnatal airway management. Fisher's exact test was used to compare management decisions, outcomes, and imaging findings. Results: Thirty-seven patients met inclusion criteria. The most common diagnoses observed were lymphatic malformation, teratoma, and micrognathia. Of the imaging findings collected, only midline neck mass location was associated with EXIT procedure performance. Factors associated with invasive airway support at birth were mass-induced in-utero neck extension and neck vessel compression, polyhydramnios, and micrognathia. Conclusions: Multidisciplinary input and interpretation of prenatal imaging can guide management of fetal airway-related pathology. EXIT is an overall safe procedure and can decrease risk due to airway obstruction at birth. We identified in-utero neck extension, neck vessel compression, micrognathia, and polyhydramnios as better indicators of a need for invasive airways measures at birth and suggest use of these criteria in combination with clinical judgement when recommending EXIT.

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Ex utero intrapartum treatment (EXIT) for fetal neck masses: A tertiary center experience and literature review

Cited by 24 publications

References 55 publications

EXIT: Estado del arte y cómo lo hacemos

EXIT: Estado del arte y cómo lo hacemos

Airway management for neonates requiring ex utero intrapartum treatment (EXIT)

Prenatal Imaging Findings Predict Obstructive Fetal Airways Requiring EXIT

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