Extracorporeal membrane oxygenation as a bridge to definitive tracheal reconstruction in neonates

J Pediatr Surg. 2008 May;43(5):800-4. doi: 10.1016/j.jpedsurg.2007.12.014.

Abstract

Purpose: Infants born with severe tracheal anomalies may not survive beyond the first few hours of life without aggressive cardiopulmonary support and/or emergent airway surgery. The purpose of this study was to review our experience with critically ill neonates supported on extracorporeal membrane oxygenation (ECMO) before tracheal reconstruction.

Methods: A retrospective review of a single institution ECMO registry was conducted. Outcomes of neonates requiring tracheal repair were examined.

Results: Three children with tracheal anomalies (complete tracheal rings [n = 2]; bronchogenic cyst [n = 1]) underwent definitive airway reconstruction. All were placed on ECMO (venovenous [n = 2]; venoarterial [n = 1]) within 24 hours after birth. Tracheoplasties (tracheal resection with end-to-end anastomosis [n = 1]; slide tracheoplasty [n = 1]; carinal resection and reconstruction [n = 1]) were performed at 3.7 +/- 2.2 days of life. There were no hemorrhagic or thrombotic complications for an ECMO time of 117.3 +/- 60.1 hours. The postoperative durations until extubation and hospital discharge were 12.0 +/- 3.2 and 34.3 +/- 11.6 days, respectively. All children remain alive and well without cardiopulmonary and neurologic sequelae at a mean follow-up of 4.5 years.

Conclusions: Excellent clinical outcomes can be achieved in neonates born with severe tracheal anomalies using ECMO as a bridge to definitive tracheal reconstruction.

Publication types

  • Case Reports

MeSH terms

  • Extracorporeal Membrane Oxygenation / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Infant, Newborn
  • Reconstructive Surgical Procedures / methods*
  • Retrospective Studies
  • Trachea / abnormalities*
  • Trachea / surgery*
  • Tracheal Stenosis / congenital*
  • Tracheal Stenosis / surgery*
  • Treatment Outcome