title: Extracorporeal Membrane Oxygenation for Cardiopulmonary Failure During Pregnancy and Postpartum.
abstract: BACKGROUND
  Extracorporeal membrane oxygenation (ECMO) has been used with increasing frequency to support pregnant and postpartum patients with severe cardiac or pulmonary failure, although patient management and clinical outcomes are underreported. This study represents patients who received ECMO during the peripartum period.
  
  
  METHODS
  All pregnant or postpartum patients treated with ECMO in the medical intensive care unit between January 1, 2009, and June 30, 2015, were included in this study. Data were analyzed retrospectively. The primary objective was to characterize the circumstances and clinical characteristics of the patients who received ECMO, describe our management during pregnancy and at the time of delivery, evaluate maternal and fetal outcomes, and report bleeding and thrombotic complications.
  
  
  RESULTS
  Eighteen peripartum patients were treated with ECMO during the study period; 4 were pregnant at the time of cannulation. Median age was 32.6 years, and median gestational age in pregnant patients was 32 weeks. Sixteen patients (88.9%) survived to hospital discharge. Fetal survival was 14 (77.8%) in the entire cohort and 100% in patients cannulated after fetal viability. Two patients successfully delivered on ECMO. Bleeding complications developed in 6 patients (33.3%) and were associated with disseminated intravascular coagulation. No fetal complications were attributed to ECMO.
  
  
  CONCLUSIONS
  ECMO can be used during pregnancy and postpartum with favorable maternal and fetal outcomes, and it outweighs the risk of bleeding or thrombotic complications when managed by an experienced, multidisciplinary team.
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York.
authors.forename: Cara
authors.initials: C
authors.lastname: Agerstrand
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York.
authors.forename: Darryl
authors.initials: D
authors.lastname: Abrams
authors.affiliation: Department of Surgery, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York.
authors.forename: Mauer
authors.initials: M
authors.lastname: Biscotti
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York.
authors.forename: Leslie
authors.initials: L
authors.lastname: Moroz
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York.
authors.forename: Erika B
authors.initials: EB
authors.lastname: Rosenzweig
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York.
authors.forename: Mary
authors.initials: M
authors.lastname: D'Alton
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York. Electronic address: hdb5@cumc.columbia.edu.
authors.forename: Daniel
authors.initials: D
authors.lastname: Brodie
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York.
authors.forename: Matthew
authors.initials: M
authors.lastname: Bacchetta
mesh_terms: D000328:Adult; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D011644:Puerperal Disorders / Q000628:therapy*; D012128:Respiratory Distress Syndrome / Q000628:therapy*