Survival rates of extracorporeal membrane oxygenation use in obstetric patients: A retrospective cohort study

Abstract

<h3>Objectives</h3> Little is known about the use of extracorporeal membrane oxygenation (ECMO) in pregnant patients. The objective of our study is to estimate the rate of ECMO use in pregnant patients, identify clinical conditions leading to ECMO use, and assess survival rates by causal condition. <h3>Methods</h3> Using the Healthcare Cost and Utilization Project – Nationwide Inpatient Sample database, we conducted a retrospective cohort study consisting of all delivery admissions in the United States from 1999-October 1st, 2015. Within the cohort, we identified women who received ECMO therapy using the ICD-9 code 39.65. We used descriptive analyses to estimate survival rates for women who received ECMO based on their associated diagnosis. <h3>Results</h3> A cohort of 15,335,288 deliveries was identified. Overall incidence of ECMO use was 0.57/100,000 pregnancies. Incidence of ECMO use increased from 0.23/100,000 in 1999 to 2.57/100,000 in 2015. ECMO patients were more likely to be older, have lower income, and have pre-existing medical conditions when compared with the non-ECMO patients. The overall survival rate for the ECMO group was 62.7%. The most common reason for ECMO placement was acute respiratory failure. The etiologies associated with the highest survival in the ECMO group were pneumonia and venous thromboembolism, which were found to have survival rates of 75.0% and 81.0%, respectively. <h3>Conclusions</h3> The incidence of ECMO use in the obstetric population has 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.