J Extra Corpor Technol
Volume 52, Number 3, September 2020
|Page(s)||191 - 195|
|Published online||15 September 2020|
Extracorporeal Membrane Oxygenation Utility in Postpartum Patients
* Department of Critical Care, Pulmonary, and Sleep Medicine, and ‡ Center for Advanced Heart Failure, Memorial Hermann Hospital Heart & Vascular Institute, Houston, Texas; § Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas; and ¶ Department of Anesthesia, University of Texas M.D. Anderson Cancer Center, Houston, Texas
† Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
Address correspondence to: Biswajit Kar, MD, Center for Advanced Heart Failure, 6400 Fannin St., Suite 2350, Houston, TX 77030. E-mail: email@example.com
Accepted: 14 May 2020
Although extracorporeal membrane oxygenation (ECMO) has been used in many different populations, its use in pregnant or postpartum patients has not been widely studied. This article reviews the ECMO experience in this population at a large urban hospital. Electronic medical records for all pregnant or postpartum patients who required ECMO between 2012 and 2019 were retrospectively reviewed. Data on clinical characteristics, outcomes, and complications were gathered. Comparisons between survivors and nonsurvivors were completed. Ten postpartum patients were identified. The patients presented as follows: four with cardiac arrest, one with a massive pulmonary embolism, three with acute respiratory distress syndrome (ARDS), one with combined ARDS and cardiogenic shock, and one with suspected amniotic embolism. Survival to decannulation was 70%, and survival to discharge was 60%. When comparing survivors vs. nonsurvivors, ECMO survivors tended to have shorter support times vs. nonsurvivors. Otherwise, no differences were noted in age, mechanical ventilation time, or length of stay. Disseminated intravascular coagulation was a common phenomenon in this patient cohort. After initiation of ECMO, elevated serum lactate levels, lower systolic blood pressure, and acute renal failure were predictors of mortality. In a single institution at a large metroplex, we present data regarding the use of ECMO in postpartum patients. ECMO can be successfully used in selected postpartum patients with severe cardiac or respiratory dysfunction. Multidisciplinary collaboration on a regular basis will streamline the ECMO referral in a timely manner. Furthermore, larger studies are indicated to understand the utility of ECMO in larger cohorts.
Key words: ECMO / postpartum / heart failure / ARDS
Disclosure: The authors disclose receiving general transfers of value from pharmaceutical or device companies in the form of Food and Beverage or Education; however, the support received was not related to this article nor does it rise to the level of a significant conflict of interest.
© 2020 AMSECT
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