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Use of extracorporeal membrane oxygenation in obstetric patients: a retrospective cohort study

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

There is little information on the use of extracorporeal membrane oxygenation (ECMO) in pregnant women. Our objectives are to estimate the use of ECMO in pregnant patients, identify clinical conditions associated with ECMO use, and assess survival rates by the associated condition.

Methods

Using the Healthcare Cost and Utilization Project–Nationwide Inpatient Sample, we carried out a retrospective cohort study of all delivery admissions in the United States from January 1, 1999, to October 1, 2015. Within the cohort, women who received ECMO therapy were identified using ICD-9 codes and then survival rates among these women were calculated.

Results

There were 83 women who underwent ECMO therapy in our cohort of 15,335,205 births, for an overall ECMO use rate of 0.54/100,000 pregnancies. The incidence of ECMO use increased from 0.23/100,000 in 1999 to 2.57/100,000 in 2015. Patients on ECMO were more likely to be older, have a lower income, and have pre-existing medical conditions when compared with the patients not on ECMO. The overall survival rate for the ECMO group was 62.7%. The most common reason for ECMO use was acute respiratory failure. Etiologies associated with the highest survival in those on ECMO were pneumonia and venous thromboembolism, which were found to have survival rates of 75.0% and 81.0%, respectively.

Conclusion

The incidence of ECMO use in the obstetric population increased over the last decade and a half. Although it carries a limited survival rate within this population, it has proven life-saving for many suffering from complications of pregnancy and delivery.

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References

  1. ELSO Guidelines for Cardiopulmonary Extracorporeal Life Support (2013) Extracorporeal Life Support Organization. Ann Arbor, MI, USA. www.elsonet.org. Accessed 20 Nov 2019

  2. ECLS Registry Report: International Summary (2018) Extracorporeal Life Support Organization. Ann Arbor, MI, USA. https://www.elso.org/Registry/Statistics/InternationalSummary.aspx. Accessed 20 Nov 2019

  3. Clardy PF, Reardon CC (2018) Critical illness during pregnancy and the peripartum period. Available from: https://www.uptodate.com/contents/critical-illness-during-pregnancy-and-the-peripartum-period. Accessed 20 Nov 2019

  4. Pregnancy-Related Deaths (2018) Centers for disease control and prevention. Available from: https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-relatedmortality.htm. Accessed 25 Jan 2019

  5. Building U.S. Capacity to Review and Prevent Maternal Deaths (2018). Report from nine maternal mortality review committees. https://reviewtoaction.org/Report_from_Nine_MMRCs. Accessed 25 Jan 2019.

  6. Sharma NS, Wille KM, Bellot SC, Diaz-Guzman E (2015) Modern use of extracorporeal life support in pregnancy and postpartum. ASAIO J 61:110–114 (American Society for Artificial Internal Organs : 1992)

    Article  Google Scholar 

  7. Webster CM, Manuck T (2019) 836: Extracorporeal membrane oxygenation in pregnant and postpartum women: a ten-year cohort. Am J Obstet Gynecol 220:S545–S546

    Article  Google Scholar 

  8. HCUP Databases Rockland, MD.: Agency for healthcare research and quality; 2006–2009. Available from: https://www.hcup-us.ahrq.gov/databases.jsp. Accessed 20 Nov 2019

  9. HCUP National Inpatient Sample (NIS) (2012) Healthcare Cost and Utilization Project (HCUP). www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed 20 Nov 2019

  10. Bokman CL, Tashiro J, Perez EA, Lasko DS, Sola JE (2015) Determinants of survival and resource utilization for pediatric extracorporeal membrane oxygenation in the United States 1997–2009. J Pediatric Surg 50:809–814

    Article  Google Scholar 

  11. Wallace DJ, Angus DC, Seymour CW, Yealy DM, Carr BG, Kurland K et al (2014) Geographic access to high capability severe acute respiratory failure centers in the United States. PLoS ONE 9:e94057

    Article  Google Scholar 

  12. Sauer CM, Yuh DD, Bonde P (2015) Extracorporeal membrane oxygenation use has increased by 433% in adults in the United States from 2006 to 2011. ASAIO J 61:31–36 (American Society for Artificial Internal Organs : 1992)

    Article  CAS  Google Scholar 

  13. Elbadawi A, Mentias A, Elgendy IY, Mohamed AH, Syed MH, Ogunbayo GO et al (2019) National trends and outcomes for extra-corporeal membrane oxygenation use in high-risk pulmonary embolism. Vascr Med (London, England) 24:230–233

    Article  Google Scholar 

  14. Agerstrand C, Abrams D, Biscotti M, Moroz L, Rosenzweig EB, D'Alton M et al (2016) Extracorporeal membrane oxygenation for cardiopulmonary failure during pregnancy and postpartum. Ann Thoracic Surg 102:774–779

    Article  Google Scholar 

  15. Aubron C, Cheng AC, Pilcher D, Leong T, Magrin G, Cooper DJ et al (2013) Factors associated with outcomes of patients on extracorporeal membrane oxygenation support: a 5-year cohort study. Crit Care (London, England) 17:R73

    Article  Google Scholar 

  16. Maternal adaptations to pregnancy (2017) Cardiovascular and hemodynamic changes. Available from: https://www.uptodate.com/contents/maternal-adaptations-to-pregnancy-cardiovascular-and-hemodynamic-changes. Accessed 20 Nov 2019

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1E2, Canada

    Natasha Sebastian & Haim A. Abenhaim

  2. Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, QC, Canada

    Nicholas Czuzoj-Shulman, Andrea R. Spence & Haim A. Abenhaim

Authors
  1. Natasha Sebastian
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  2. Nicholas Czuzoj-Shulman
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  3. Andrea R. Spence
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  4. Haim A. Abenhaim
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Contributions

NS: contributed to study design; interpretation of data; drafting of the manuscript; read and approved the final version of the manuscript. NC-S: data management; formal data analysis; revision of the manuscript; read and approved the final version of the manuscript. AS: contributed to study design; interpretation of data; revising of original manuscript; read and approved the final version of the manuscript. HA: conception and design; acquisition of data; supervision of analyses; interpretation of data; critical revision of the manuscript for important intellectual content; read and approved the final version of the manuscript.

Corresponding author

Correspondence to Haim A. Abenhaim.

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Conflict of interest

The authors report no conflict of interest. We had full control of all primary data and we agree to allow the Journal to review this data if requested.

Research involving human participants

This study exclusively used data from an existing administrative database. This data was publicly available; hence, according to the Tri-Council Policy statement (2010), institutional review board approval was not required.

Informed consent

This study used publicly available data; hence, we did not personally obtain informed consent from study subjects. This would be the responsibility of the Agency for Healthcare Research and Quality (AHRQ), who sponsors the National Inpatient Sample.

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Sebastian, N., Czuzoj-Shulman, N., Spence, A.R. et al. Use of extracorporeal membrane oxygenation in obstetric patients: a retrospective cohort study. Arch Gynecol Obstet 301, 1377–1382 (2020). https://doi.org/10.1007/s00404-020-05530-5

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  • DOI: https://doi.org/10.1007/s00404-020-05530-5

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