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The EXIT procedure is an important strategy in the management of prenatally diagnosed congenital malformations. EXIT procedures offer the advantage of ensuring uteroplacental gas exchange while on placental support. The EXIT procedure helps enable surgeons to transform a potentially fatal neonatal emergency into a controlled environment to ensure a better outcome.
EXIT procedures are performed at Cincinnati Children’s in an operating room that is specifically designed for performing fetal procedures and equipped to treat mother and baby in one location.
EXIT-to-Resection of high-risk tumor
Total EXIT procedures
During the EXIT procedure, the goals are to:
The EXIT-to-ECMO strategy is useful in cases of severe pulmonary or cardiac malformations in which separation from the uteroplacental circulation will lead to immediate instability in the newborn. In such cases, EXIT-to-ECMO strategy can be applied to secure the airway and insert venous and arterial cannulas for ECMO while on placental support.
This approach avoids any period of hypoxia or acidosis during neonatal resuscitation. The Cincinnati Fetal Center currently offers EXIT-to-ECMO in cases of high-risk congenital diaphragmatic hernia (CDH) with lung-head circumference ratios (LHR) less than 1.0 with associated liver herniation, which is the highest risk category for mortality and morbidity.
We also offer EXIT-to-ECMO for cases of severe aortic stenosis (AS) or hypoplastic left heart syndrome (HLHS) when they are associated with restrictive atrial septum in which severe instability would be anticipated before the newborn can be transferred from the delivery room to the cardiac catheterization lab at Cincinnati Children’s.
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