title: Extracorporeal membrane oxygenation for severe ARDS in pregnant and postpartum women during the 2009 H1N1 pandemic.
abstract: OBJECTIVE
  To describe the technical challenges, efficacy, complications and maternal and infant outcomes associated with extracorporeal membrane oxygenation (ECMO) for severe adult respiratory distress syndrome (ARDS) in pregnant or postpartum patients during the 2009 H1N1 pandemic.
  
  
  METHODS
  Twelve critically ill pregnant and postpartum women were included in this retrospective observational study on the application of ECMO for the treatment of severe ARDS refractory to standard treatment. The study was conducted at seven tertiary hospitals in Australia and New Zealand.
  
  
  RESULTS
  Of the 12 patients treated with ECMO, 7 (58%) were pregnant and 5 (42%) were postpartum. Their median (interquartile range [IQR]) age was 29 (26-33) years, 6 (50%) were obese. Two patients were initially treated with veno-arterial (VA) ECMO. All others received veno-venous (VV) ECMO with one or two drainage cannulae. ECMO circuit-related complications were rare, circuit change was needed in only two cases and there was no sudden circuit failure. On the other hand, bleeding was common, leading to relatively large volumes of packed red blood cell transfusion (median [IQR] volume transfused was 3,499 [1,451-4,874] ml) and was the main cause of death (three cases). Eight (66%) patients survived to discharge and seven were ambulant, with normal oxygen saturations. The survival rate of infants whose mothers received ECMO was 71% and surviving infants were discharged home with no sequelae.
  
  
  CONCLUSIONS
  The use of ECMO for severe ARDS in pregnant and postpartum women was associated with a 66% survival rate. The most common cause of death was bleeding. Infants delivered of mothers who had received ECMO had a 71% survival rate and, like their mothers, had no permanent sequelae at hospital discharge.
authors.affiliation: Department of Intensive Care, Intensive Care Unit, St Vincents Hospital, Sydney, NSW, 2010, Australia. pnair@stvincents.com.au
authors.forename: Priya
authors.initials: P
authors.lastname: Nair
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Davies
authors.forename: John
authors.initials: J
authors.lastname: Beca
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
authors.forename: David
authors.initials: D
authors.lastname: Ellwood
authors.forename: Paul
authors.initials: P
authors.lastname: Forrest
authors.forename: Andrew
authors.initials: A
authors.lastname: Jackson
authors.forename: Roger
authors.initials: R
authors.lastname: Pye
authors.forename: Ian
authors.initials: I
authors.lastname: Seppelt
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Sullivan
authors.forename: Steve
authors.initials: S
authors.lastname: Webb
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000453:epidemiology*; D007362:Intensive Care Units; D009520:New Zealand / Q000453:epidemiology; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000453:epidemiology; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult