We Can Do It: The First EXIT Procedure at NMCSD

By Cmdr. (Dr.) Matthew T. Brigger, pediatric otolaryngologist and Residency Program Director for the Otolaryngology – Head and Neck Surgery Department, Naval Medical Center San Diego

BRIGGER“We can do it.”  That was the first thought that went through my mind when I received a call from Dr. Whitney You, Naval Medical Center San Diego’s head of Maternal Fetal Medicine, asking whether NMCSD could support an EXIT procedure.  Weeks later, I learned that the same thought raced through her mind the night before she called me.  

The EXIT procedure is an acronym for Ex-utero Intrapartum Treatment. In short, the procedure is an intervention at the time of birth. Dr. You and her team had expertly identified abnormalities that suggested Charlie was at risk of having life threatening breathing difficulties at birth. As I reviewed the data, it was clear that an EXIT procedure was his best opportunity. Charlie would be partially delivered, and we would ensure that he had a safe airway while he was still receiving oxygen from the umbilical cord. Once we knew he would be able to safely breathe, he would be completely delivered.   

Only a handful of top tier medical centers have significant experience in performing EXIT procedures. Although such a procedure had never been performed at NMCSD, the components were in place. We have well trained specialists from the finest civilian academic institutions.  As such, we built the team encompassing 30 doctors, nurses, corpsmen and techs.

The EXIT procedure meant we had to harness our strengths and execute in a highly coordinated fashion. As with most things in life, the complexities lie in the contingencies. During the procedure, a wide variety of complications could place both Charlie and his mother in imminent danger. As a team, we had to ensure that we were prepared. In addition to multiple meetings, we staged an elaborate simulation that lasted several hours the day before his delivery. We were ready.

A surgical team at Naval Medical Center San Diego perform an ex-utero intrapartum treatment (EXIT) procedure on a mother and her newborn son to correct an in-utero medical condition. The baby was born at 35 weeks four days. This was the first time the EXIT procedure was performed at Naval Medical Center San Diego. (U.S. Navy photo by Mass Communication Specialist 2nd Class John Philip Wagner, Jr.)
A surgical team at Naval Medical Center San Diego perform an ex-utero intrapartum treatment (EXIT) procedure on a mother and her newborn son to correct an in-utero medical condition. The baby was born at 35 weeks four days. This was the first time the EXIT procedure was performed at Naval Medical Center San Diego. (U.S. Navy photo by Mass Communication Specialist 2nd Class John Philip Wagner, Jr.)

Feb.27th arrived and it was time for Charlie to be born. I knew there was no better place for Charlie to be that day.  Just over an hour after arriving to the operating room, under the watchful eyes of the team as well as the entire NMCSD family, Charlie was born.  His airway was secure and both he and his mother were safely recovering. Every aspect of the procedure went according to plan. The team functioned flawlessly. 

Charlie still has significant challenges facing him. However, he has a much better chance at overcoming his issues because of the expertise and teamwork at NMCSD. He represents a significant milestone for our institution and Navy Medicine as an example of delivering world-class care not only to adults, but children as well.

As a team, we are all proud to have made a difference that day.

*Editor’s note: Cmdr. (Dr.) Brigger was commissioned in 1997 after completing his undergraduate degree in Mechanical Engineering at Vanderbilt University.  He graduated from the University Of Cincinnati College Of Medicine and completed the National Capital Consortium Otolaryngology-Head and Neck Surgery Residency in 2007.  He then subspecialized in Pediatric Otolaryngology at the Massachusetts Eye and Ear Infirmary/Harvard Medical School and received a Masters of Public Health degree from the Harvard School of Public Health in 2009.  Since that time, he has served at NMCSD maintaining a busy academic practice and has receiving local and national accolades for his commitment to teaching and strengthening academic medicine. 

For more information on the EXIT Procedure, visit:

http://www.navy.mil/submit/display.asp?story_id=72496

http://www.navy.mil/viewVideo.asp?id=18208