Extracorporeal Life Support for Cardiorespiratory Collapse After Delayed Diagnosis and Related Complications of Postpartum Preeclampsia

Abstract

AS CLINICIANS PUSH FORWARD into the future of obstetrical care and mechanical circulatory support, they will increasingly find these 2 seemingly separate environments intersecting as complexity grows within the obstetric population. Care for these challenging patients brings to light the present systemic biases that are integrated into the very medical infrastructure from which care is provided. The case presented here highlights these facts, and demonstrates a need for clinical and systemic growth and improvement regarding the recognition of peripartum complications and the need to mitigate the morbidity and mortality associated with potential bias. In this case, the use of mechanical circulatory support was only necessary because of repeated failures to intervene prior to the patient's decompensation. Though the authors’ institution, and many others, are capable of such heroics, the bigger question lies in why this happened at all and how can this need be prevented, rather than celebrate its success. Invited Commentary on the Postpartum Preeclampsia ECMO Case ConferenceJournal of Cardiothoracic and Vascular AnesthesiaPreviewPREGNANCY, DESPITE its common nature and reputation as a “natural stage” of female existence, has profound physiologic effects. The cardiovascular system evolves as early as 6 weeks' gestation to establish appropriate uteroplacental circulation to support a growing fetus and supply the increased demands on maternal metabolism.1 Cardiac output increases throughout pregnancy and can reach up to 150% of prepregnancy levels by the twenty-fourth week, and is largely achieved by an increase in stroke volume; cardiac magnetic resonance imaging demonstrates increases in left ventricular end-diastolic volume and left ventricular mass. Full-Text PDF