Extracorporeal Membrane Oxygenation for Cardiopulmonary Failure During Pregnancy and Postpartum

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• 作者：Cara Agerstrand ; MD^a ; Darryl Abrams ; MD^a ; Mauer Biscotti ; MD^b ; Leslie Moroz ; MD^c ; Erika B. Rosenzweig ; MD^d ; Mary D&rsquo ; Alton ; MD^c ; Daniel Brodie ; MD^a ; ^&lowast ; ; ^{hdb5@cumc.columbia.edu" class="auth_mail" title="E-mail the corresponding author} ; Matthew Bacchetta ; MD ; MBA^e ; ^&lowast ;
• 关键词：APACHE ; Acute Physiology and Chronic Health Evaluation ; ARDS ; acute respiratory distress syndrome ; ECMO ; extracorporeal membrane oxygenation ; ECPR ; extracorporeal cardiopulmonary resuscitation ; DIC ; disseminated intravascular coagulation ; DVT ; deep vein thrombosis ; FIO2 ; fraction of inspired oxygen ; ICU ; intensive care unit ; IQR ; interquartile range ; PaCO2 ; partial pressure of arterial carbon dioxide ; PaO2 ; partial pressure of arterial oxygen
• 刊名：The Annals of Thoracic Surgery
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：102
• 期：3
• 页码：774-779
• 全文大小：125 K

文摘

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.