836: Extracorporeal membrane oxygenation in pregnant and postpartum women: a ten-year cohort

Abstract

Extracorporeal membrane oxygenation (ECMO) is a life-saving therapy for severe, reversible cardiopulmonary failure. ECMO survival in the general adult population is 50-70%, and available data on ECMO use in obstetric patients is reassuring, with survival rates approaching 80%; however, <100 cases of peripartum ECMO use are described in the literature. We sought to quantify peripartum maternal survival of ECMO in a contemporary cohort at a single tertiary institution. All women, aged 14-54yo, who underwent ECMO at our institution between January 1, 2008 and December 31, 2017 were identified using a query of hospital encounters for ECMO-related CPT codes. Chart review was utilized to determine peripartum status (pregnant or < 6 weeks postpartum). Clinical characteristics as well as maternal and fetal outcomes are described. Fifty-four women of reproductive age underwent ECMO for cardiopulmonary failure during the study period. Of those, 9 (17%) were peripartum: 3 antepartum, 6 postpartum (Table 1). Overall, peripartum maternal survival was 33% (vs. 51% of those not peripartum). The median maternal age was 24yo (range 19-39), and the majority of women were non-smokers without underlying medical comorbidies. The most common indication for peripartum ECMO use was ARDS, present in 7 cases (78%), including 5 infectious etiologies and 2 cases of preeclampsia. The median number of days on ECMO was 6 (range 1-14), and there were no cases of obstetrical hemorrhage. Venovenous ECMO was utilized in all but one case, in which venoarterial ECMO was unsuccessful in resuscitating a postpartum patient with a massive pulmonary embolism and cardiac arrest. Among the 3 antepartum patients, maternal survival was 33%, fetal survival was 67%, and gestational age at ECMO initiation was 21, 29, and 30 weeks. There was one SVD of a live infant on ECMO. In this peripartum cohort of women who underwent ECMO, maternal survival was substantially lower than currently reported in the literature. Maternal survival was also substantially lower than that of the non- peripartum reproductive-aged women who underwent ECMO at our institution in the same time period. More information is needed on the safety and efficacy of peripartum ECMO use.