Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Dec 1;135(6):1172-1179.
doi: 10.1213/ANE.0000000000006210. Epub 2022 Nov 16.

Predictors and Hospital Outcomes in Pregnant Patients Undergoing Extracorporeal Membrane Oxygenation: A Nationwide Study

Oscar F C van den Bosch  1 , Rabail Chaudhry  1 , James Wicker  2 , Talha Mubashir  3 , Daniel Limb  3 , Rohit Jogendran  4 , Laveena Munshi  5 , Mrinalini Balki  1   6   7   8
Affiliations

Predictors and Hospital Outcomes in Pregnant Patients Undergoing Extracorporeal Membrane Oxygenation: A Nationwide Study

Oscar F C van den Bosch et al. Anesth Analg. .

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) is increasingly used in patients with severe cardiorespiratory collapse. Although prior large database reviews of ECMO use in the peripartum population exist, they do not stratify by ECMO indication nor do they include obstetric conditions such as preeclampsia. Our objective was to characterize the incidence, indication-associated mortality, and factors associated with mortality in pregnant patients who underwent ECMO.

Methods: We examined the United States National Inpatient Sample database to identify hospitalizations for pregnancy from January 1, 2010 to December 31, 2016. We identified pregnant patients who underwent ECMO using International Classification of Diseases ninth and tenth revisions codes. The primary outcome was in-hospital all-cause mortality across pregnant patients who underwent ECMO for any indication. We evaluated the indication for ECMO, incidence, prevalence of risk factors, comorbidities and conditions, and their association with in-hospital mortality.

Results: Fifty-nine of 5'346,517 pregnant patients underwent ECMO during our study period (incidence, 1.1; 95% confidence interval [CI], 0.84-1.4 per 100,000 hospitalizations). Indications for ECMO support included respiratory failure (79.7%), cardiogenic shock (64.4%), or circulatory arrest (25.4%). Most patients (57.6%) had more than 1 indication. The overall in-hospital mortality rate was 30.5%. Mortality was 29.8% in patients with respiratory failure, 39.5% with cardiogenic shock, 46.7% with cardiac arrest, and 42.4% in those with combined diagnoses. Cardiogenic shock was associated with a significantly higher mortality rate and adjusted odds ratio 5.0 (95% CI, 1.25-27.0). Most patients (62.7%) had one or more comorbidities.

Conclusions: The frequency of ECMO use across the pregnant population was low over this time period, with a mortality rate of 1 in 3 patients. Mortality was greatest in patients with cardiogenic shock. Further work is needed to understand how best to improve ECMO outcomes in pregnant patients.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Comment in

References

    1. Patel AR, Patel AR, Singh S, Singh S, Khawaja I. Applied uses of extracorporeal membrane oxygenation therapy. Cureus. 2019;11:e5163.
    1. Zhang JJY, Ong JA, Syn NL, et al. Extracorporeal membrane oxygenation in pregnant and postpartum women: a systematic review and meta-regression analysis. J Intensive Care Med. 2021;36:220–228.
    1. Rush B, Martinka P, Kilb B, McDermid RC, Boyd JH, Celi LA. Acute respiratory distress syndrome in pregnant women. Obstet Gynecol. 2017;129:530–535.
    1. Banayan J, Rana S, Mueller A, et al. Cardiogenic shock in pregnancy: analysis from the National Inpatient Sample. Hypertens Pregnancy. 2017;36:117–123.
    1. Combes A, Hajage D, Capellier G, et al.; EOLIA Trial Group, REVA, and ECMONet. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med. 2018;378:1965–1975.

Publication types