Veno-arterial ECMO in pregnant and postpartum patients with cardiogenic shock resulted in 80% maternal and fetal survival to discharge.
Case Report (n=5)
No
Does VA ECMO improve survival in pregnant and postpartum patients with cardiogenic shock?
VA ECMO can be successfully utilized as a life-saving intervention in pregnant and postpartum patients with cardiogenic shock, achieving 80% survival to discharge despite significant bleeding risks.
BACKGROUND: The use of veno-arterial extracorporeal membrane oxygenation (VA ECMO) for cardiogenic shock in pregnant and postpartum patients remains limited by concerns of bleeding, hemolysis, and fetal risks. This case series examines the underlying characteristics and management strategies for this high-risk population. METHODS: delivery, left ventricular (LV) unloading, anticoagulation, and ECMO circuit characteristics were evaluated. RESULTS: Five patients required veno-arterial ECMO for restoration of systemic perfusion. Three patients developed peripartum cardiomyopathy, one septic cardiomyopathy, and one acute right ventricular (RV) failure. The median age was 30.6 years, with median gestational age in pregnant patients of 31 weeks. Maternal and fetal survival to discharge was 80%. Bleeding was the primary complication, with two patients requiring blood transfusions; one requiring interventional radiology (IR) embolization and the other requiring surgical intervention to control bleeding. One patient was successfully delivered on VA ECMO. No fetal complications were directly attributed to VA ECMO. CONCLUSIONS: VA ECMO can be employed successfully in obstetric patients with cardiogenic shock with appropriate patient selection. Further research is needed to determine if VA ECMO provides a survival advantage over traditional management strategies in this vulnerable population.
Desai et al. (Fri,) conducted a case report in Cardiogenic shock during pregnancy and postpartum (n=5). Veno-arterial extracorporeal membrane oxygenation (VA ECMO) was evaluated on Maternal and fetal survival to discharge. Veno-arterial ECMO in pregnant and postpartum patients with cardiogenic shock resulted in 80% maternal and fetal survival to discharge.