Pregnancy-Associated Extracorporeal Membrane Oxygenation in the United States

Abstract

Objective The use of extracorporeal membrane oxygenation (ECMO) therapy has increased in the adult population. Studies from the H1N1 influenza pandemic suggest that ECMO deployment in pregnancy is associated with favorable outcomes. With increasing numbers of pregnant women affected by COVID-19 (coronavirus disease 2019) and potentially requiring this life-saving therapy, we sought to compare comorbidities, costs, and outcomes between pregnancy- and nonpregnancy-associated ECMO therapy among reproductive-aged female patients.

Study Design We used the 2013 to 2019 National Readmissions Database. Diagnosis and procedural coding were used to identify ECMO deployment, potential indications, comorbid conditions, and pregnancy outcomes. The primary outcome was in-hospital mortality during the patient's initial ECMO stay. Secondary outcomes included length of stay and hospital charges/costs, occurrence of thromboembolic or bleeding complications during ECMO hospitalization, and mortality and readmissions up to 330 days following ECMO stay. Univariate and multivariate regression models were used to model the associations between pregnancy status and outcomes.

Results The sample included 324 pregnancy-associated hospitalizations and 3,805 nonpregnancy-associated hospitalizations, corresponding to national estimates of 665 and 7,653 over the study period, respectively. Pregnancy-associated ECMO had lower incidence of in-hospital death (adjusted odds ratio [aOR]: 0.56, 95% confidence interval [CI]: 0.41–0.75) and bleeding complications (aOR: 0.67, 95% CI: 0.49–0.93). Length of stay was significantly shorter (adjusted rate ratio (aRR): 0.86, 95% CI: 0.77–0.96) and total hospital costs were less (aRR: 0.83, 95% CI: 0.75–0.93). Differences in the incidence of thromboembolic events (aOR: 1.04, 95% CI: 0.78–1.38) were not statistically significant.

Conclusion Pregnancy-associated ECMO therapy had lower incidence of in-hospital death, bleeding complications, total inpatient cost, and length of stay when compared with nonpregnancy-associated ECMO therapy without increased thromboembolic complications. Pregnancy-associated ECMO therapy should be offered to eligible patients.

Key Points

• Pregnancy-related ECMO use was compared with nonpregnant use.

• Outcomes were equal or favored pregnancy-related deployment.

• These data may be useful when considering ECMO use in pregnancy.

Keywords

extracorporeal membrane oxygenation - pregnancy - respiratory failure - heart failure

Note

This article was presented in a preliminary form at the 2022 Society for Maternal Fetal Medicine meeting (held virtually January 31–February 5, 2022).

Publication History

Received: 10 May 2022

Accepted: 16 December 2022

Accepted Manuscript online:
06 January 2023

Article published online:
15 February 2023

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