Abstract
The ex utero intrapartum treatment (EXIT) procedure was primarily devel-oped to reverse temporary tracheal occlu-sion in patients with fetal surgery for con-genital diaphragmatic hernia. Nowadays, it is widely used to resect fetal neck masses and to maintain an unobstructed airway. It is indicated for the management of several cardiothoracic diseases, including medi-astinal or lung mass resection, drainage of pleural effusions, palliative treatment of critical congenital heart disease and establishment of EXIT-to-extracorporeal membrane oxygenation (ECMO). EXIT has been attempted successfully in many centers, and it has been proven that moth-ers and babies tolerate the procedure well. Maternal and fetal surveillance during an-esthesia is important to maintain maternal blood pressure and placental blood flow and fetal oxygenation. The aim of this arti-cle is to discuss the application of the EXIT procedure for the management of fetal car-diothoracic diseases.
Highlights
The ex utero intrapartum treatment (EXIT) procedure was primarily developed to reverse temporary tracheal occlusion in patients undergoing fetal surgery for congenital diaphragmatic hernia. [1] The EXIT procedure requires an experienced multi-disciplinary team that may include pediatric surgeons, an obstetrician, neonatologist, anesthesiologist and scrub nurses
The EXIT procedure was primarily established as a safe technique initially designed for reversal of tracheal obstruction in a fetus with severe congenital diaphragmatic hernia
The EXIT procedure has been extended to fetal anomalies where resuscitation may be compromised, including large thoracic masses, severe congenital diaphragmatic hernia, or pulmonary agenesis
Summary
The ex utero intrapartum treatment (EXIT) procedure was primarily developed to reverse temporary tracheal occlusion in patients undergoing fetal surgery for congenital diaphragmatic hernia. [1] The EXIT procedure requires an experienced multi-disciplinary team that may include pediatric surgeons, an obstetrician, neonatologist, anesthesiologist and scrub nurses. The ex utero intrapartum treatment (EXIT) procedure was primarily developed to reverse temporary tracheal occlusion in patients undergoing fetal surgery for congenital diaphragmatic hernia. [1] The EXIT procedure requires an experienced multi-disciplinary team that may include pediatric surgeons, an obstetrician, neonatologist, anesthesiologist and scrub nurses. The EXIT procedure was primarily established as a safe technique initially designed for reversal of tracheal obstruction in a fetus with severe congenital diaphragmatic hernia. [3] Liechty et al [3] reported that the mean duration of EXIT was 28 ± 22 minutes during intrapartum airway management for giant fetal neck masses. The EXIT procedure has been extended to fetal anomalies where resuscitation may be compromised, including large thoracic masses, severe congenital diaphragmatic hernia, or pulmonary agenesis. This article will discuss the application of the EXIT procedure in fetal cardiothoracic diseases
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