Cara Agerstrand1, Darryl Abrams1, Mauer Biscotti2, Leslie Moroz3, Erika B Rosenzweig4, Mary D'Alton3, Daniel Brodie5, Matthew Bacchetta6. 1. Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York. 2. Department of Surgery, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York. 3. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York. 4. Division of Pediatric Cardiology, Department of Pediatrics, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York. 5. Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York. Electronic address: hdb5@cumc.columbia.edu. 6. Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York.
Abstract
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has been used with increasing frequency to support pregnant and postpartum patients with severe cardiac or pulmonary failure, although patient management and clinical outcomes are underreported. This study represents patients who received ECMO during the peripartum period. METHODS: All pregnant or postpartum patients treated with ECMO in the medical intensive care unit between January 1, 2009, and June 30, 2015, were included in this study. Data were analyzed retrospectively. The primary objective was to characterize the circumstances and clinical characteristics of the patients who received ECMO, describe our management during pregnancy and at the time of delivery, evaluate maternal and fetal outcomes, and report bleeding and thrombotic complications. RESULTS: Eighteen peripartum patients were treated with ECMO during the study period; 4 were pregnant at the time of cannulation. Median age was 32.6 years, and median gestational age in pregnant patients was 32 weeks. Sixteen patients (88.9%) survived to hospital discharge. Fetal survival was 14 (77.8%) in the entire cohort and 100% in patients cannulated after fetal viability. Two patients successfully delivered on ECMO. Bleeding complications developed in 6 patients (33.3%) and were associated with disseminated intravascular coagulation. No fetal complications were attributed to ECMO. CONCLUSIONS: ECMO can be used during pregnancy and postpartum with favorable maternal and fetal outcomes, and it outweighs the risk of bleeding or thrombotic complications when managed by an experienced, multidisciplinary team.
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has been used with increasing frequency to support pregnant and postpartum patients with severe cardiac or pulmonary failure, although patient management and clinical outcomes are underreported. This study represents patients who received ECMO during the peripartum period. METHODS: All pregnant or postpartum patients treated with ECMO in the medical intensive care unit between January 1, 2009, and June 30, 2015, were included in this study. Data were analyzed retrospectively. The primary objective was to characterize the circumstances and clinical characteristics of the patients who received ECMO, describe our management during pregnancy and at the time of delivery, evaluate maternal and fetal outcomes, and report bleeding and thrombotic complications. RESULTS: Eighteen peripartum patients were treated with ECMO during the study period; 4 were pregnant at the time of cannulation. Median age was 32.6 years, and median gestational age in pregnant patients was 32 weeks. Sixteen patients (88.9%) survived to hospital discharge. Fetal survival was 14 (77.8%) in the entire cohort and 100% in patients cannulated after fetal viability. Two patients successfully delivered on ECMO. Bleeding complications developed in 6 patients (33.3%) and were associated with disseminated intravascular coagulation. No fetal complications were attributed to ECMO. CONCLUSIONS: ECMO can be used during pregnancy and postpartum with favorable maternal and fetal outcomes, and it outweighs the risk of bleeding or thrombotic complications when managed by an experienced, multidisciplinary team.
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