Extracorporeal membrane oxygenation in obstetric patients: An Israeli nationwide study

Author:

Yahav‐Shafir Dana12,Ilgiyaev Eduard23,Galante Ori45,Gorfil Dan26,Statlender Liran27,Soroksky Arie28,Carmi Uri29,Sinai Yitzhak Brzezinski29,Iprach Nisim210,Haviv‐Yadid Yael211,Makhoul Maged1213ORCID,Fatnic Elena1415,Ginosar Yehuda1516,Einav Sharon1517,Helviz Yigal1517,Fink Daniel1518,Sternik Leonid219,Kogan Alexander21920ORCID

Affiliation:

1. Department of Anaesthesiology Sheba Medical Centre Tel Hashomer Israel

2. Faculty of Medicine Tel Aviv University Tel Aviv Israel

3. Department of General Intensive Care Shamir Medical Center Zerifin Israel

4. Intensive Care Unit Soroka University Medical Centre Beer‐Sheva Israel

5. Faculty of Health Sciences Ben‐Gurion University of the Negev Beer‐Sheva Israel

6. Department of Cardiothoracic Surgery, Cardiothoracic Intensive Care Unit Rabin Medical Center‐Beilinson Hospital Petah Tikva Israel

7. General Intensive Care Unit Rabin Medical Center‐Beilinson Hospital Petah Tikva Israel

8. Intensive Care Unit Wolfson Medical Centre Holon Israel

9. Division of Anesthesia, Pain and Intensive Care Tel Aviv Sourasky Medical Center Tel Aviv Israel

10. Department of Anesthesia and Intensive Care Meir Medical Center Kfar‐Saba Israel

11. Intensive Care Unit Sheba Medical Center Tel Hashomer Israel

12. Department of Cardiac Surgery Rambam Medical Center Haifa Israel

13. The Ruth & Bruce Rappaport Faculty of Medicine Technion‐Israel Institute of Technology Haifa Israel

14. Department of Anesthesiology, Critical Care and Pain Medicine Hadassah Hebrew University, Ein Karem Medical Center Jerusalem Israel

15. Faculty of Medicine Hebrew University of Jerusalem Jerusalem Israel

16. Department of Anesthesiology, Mother & Child Anesthesia Unit Hadassah Hebrew University, Ein Karem Medical Center Jerusalem Israel

17. General Intensive Care Unit Shaare Zedek Medical Center Jerusalem Israel

18. Department of Cardiothoracic Surgery Shaare Zedek Medical Center Jerusalem Israel

19. Department of Cardiac Surgery Sheba Medical Centre Tel Hashomer Israel

20. Cardiac Surgery Intensive Care Unit Sheba Medical Centre Tel Hashomer Israel

Abstract

AbstractBackgroundThe leading causes of maternal mortality include respiratory failure, cardiovascular events, infections, and hemorrhages. The use of extracorporeal membrane oxygenation (ECMO) as rescue therapy in the peripartum period for cardiopulmonary failure is expanding in critical care medicine.MethodsThis retrospective observational study was conducted on a nationwide cohort in Israel. During the 3‐year period, between September 1, 2019, and August 31, 2022, all women in the peripartum period who had been supported by ECMO for respiratory or circulatory failure at 10 large Israeli hospitals were identified. Indications for ECMO, maternal and neonatal outcomes, details of ECMO support, and complications were collected.ResultsDuring the 3‐year study period, in Israel, there were 540 234 live births, and 28 obstetric patients were supported by ECMO, with an incidence of 5.2 cases per 100 000 or 1 case per 19 000 births (when excluding patients with COVID‐19, the incidence will be 2.5 cases per 100 000 births). Of these, 25 were during the postpartum period, of which 16 (64%) were connected in the PPD1, and 3 were during pregnancy. Eighteen patients (64.3%) were supported by V‐V ECMO, 9 (32.1%) by V‐A ECMO, and one (3.6%) by a VV‐A configuration. Hypoxic respiratory failure (ARDS) was the most common indication for ECMO, observed in 21 patients (75%). COVID‐19 was the cause of ARDS in 15 (53.7%) patients. The indications for the V‐A configuration were cardiomyopathy (3 patients), amniotic fluid embolism (2 patients), sepsis, and pulmonary hypertension. The maternal and fetal survival rates were 89.3% (n = 25) and 100% (n = 28). The average ECMO duration was 17.6 ± 18.6 days and the ICU stay was 29.8 ± 23.8 days. Major bleeding complications requiring surgical intervention were observed in one patient.ConclusionsThe incidence of using ECMO in the peripartum period is low. The maternal and neonatal survival rates in patients treated with ECMO are high. These results show that ECMO remains an important treatment option for obstetric patients with respiratory and/or cardiopulmonary failure.

Publisher

Wiley

Subject

Biomedical Engineering,General Medicine,Biomaterials,Medicine (miscellaneous),Bioengineering

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