학술논문
Strategies and outcomes of extracorporeal membrane oxygenation use in peripartum patients: a single institution experience.
Document Type
Academic Journal
Author
Wong RW; Tinsley Harrison Internal Medicine Residency Program, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.; Seasely AR; Division of Maternal-Fetal Medicine, UAB Department of Obstetrics and Gynecology, Birmingham, AL, USA.; Gongora E; Division of Cardiothoracic Surgery, UAB Department of Surgery, Birmingham, AL, USA.; Hoopes CW; Division of Cardiothoracic Surgery, UAB Department of Surgery, Birmingham, AL, USA.; Bellot S; Division of Cardiothoracic Surgery, UAB Department of Surgery, Birmingham, AL, USA.; McElwee SK; Division of Cardiovascular Disease, UAB Department of Medicine, Birmingham, AL, USA.; Rusanov V; Division of Pulmonary, Allergy, and Critical Care Medicine, UAB Department of Medicine, Birmingham, AL, USA.; Wille K; Division of Pulmonary, Allergy, and Critical Care Medicine, UAB Department of Medicine, Birmingham, AL, USA.; Kaleekal T; Division of Pulmonary, Allergy, and Critical Care Medicine, UAB Department of Medicine, Birmingham, AL, USA.; Marshall T; UAB Department of Mechanical Circulatory Support, Birmingham, AL, USA.; Joly JM; Division of Cardiovascular Disease, UAB Department of Medicine, Birmingham, AL, USA.; Lenneman A; Division of Cardiovascular Disease, UAB Department of Medicine, Birmingham, AL, USA.; Tallaj J; Division of Cardiovascular Disease, UAB Department of Medicine, Birmingham, AL, USA.; Pamboukian SV; Division of Cardiovascular Disease, University of Washington, Seattle, WA, USA.; Sinkey R; Division of Maternal-Fetal Medicine, UAB Department of Obstetrics and Gynecology, Birmingham, AL, USA.; Orozco-Hernandez EJ; Division of Cardiothoracic Surgery, UAB Department of Surgery, Birmingham, AL, USA.
Source
Publisher: Informa Healthcare Country of Publication: England NLM ID: 101136916 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1476-4954 (Electronic) Linking ISSN: 14764954 NLM ISO Abbreviation: J Matern Fetal Neonatal Med Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Extracorporeal membrane oxygenation (ECMO) use in peripartum patients is rare, and there is a gap in the literature on the outcomes and guidance on using ECMO in peripartum patients. This study describes ECMO strategies our institution uses for peripartum patients and reports outcomes of ECMO use in peripartum patients with respiratory and/or cardiac failure.
Methods: A case series of all peripartum patients, defined as pregnant or up to 6 weeks after delivery of an infant >20 weeks gestation, from 2018 to 2023 from a single center requiring ECMO support. Patients were included if ECMO was initiated in the setting of cardiac, pulmonary, or combined failure. Patient demographics, operative details, ECMO data, and adverse outcomes for maternal, fetus, and neonates were all collected.
Results: Eighteen patients met the inclusion criteria. The cohort had a mean maternal age of 30.7 years old and was racially diverse. A majority of this cohort tested positive for COVID-19 ( n = 10, 55%). ECMO was a bridge to recovery for all patients, of whom 14 (78%) were discharged out of the hospital alive. No patients received transplantation or a durable mechanical device. The most common complications were infection (25%) and postpartum hemorrhage (22%).
Conclusions: ECMO use in peripartum patients in a single tertiary center was associated with a high survival rate. Furthermore, a strong multidisciplinary team, careful reevaluation of clinical trajectory, and consideration of complications and risks associated with using ECMO in peripartum patients are possible frameworks to use when challenged with critically ill peripartum patients.
Methods: A case series of all peripartum patients, defined as pregnant or up to 6 weeks after delivery of an infant >20 weeks gestation, from 2018 to 2023 from a single center requiring ECMO support. Patients were included if ECMO was initiated in the setting of cardiac, pulmonary, or combined failure. Patient demographics, operative details, ECMO data, and adverse outcomes for maternal, fetus, and neonates were all collected.
Results: Eighteen patients met the inclusion criteria. The cohort had a mean maternal age of 30.7 years old and was racially diverse. A majority of this cohort tested positive for COVID-19 ( n = 10, 55%). ECMO was a bridge to recovery for all patients, of whom 14 (78%) were discharged out of the hospital alive. No patients received transplantation or a durable mechanical device. The most common complications were infection (25%) and postpartum hemorrhage (22%).
Conclusions: ECMO use in peripartum patients in a single tertiary center was associated with a high survival rate. Furthermore, a strong multidisciplinary team, careful reevaluation of clinical trajectory, and consideration of complications and risks associated with using ECMO in peripartum patients are possible frameworks to use when challenged with critically ill peripartum patients.