title: Utilization of "Stand-By" Extracorporeal Membrane Oxygenation in a High-Risk Parturient With Methamphetamine-Associated Cardiomyopathy Undergoing Dilation and Evacuation: A Case Report.
abstract: Parturients may present with evidence of acute heart failure or respiratory distress during the peripartum period. This case report documents utilization of "stand-by" extracorporeal membrane oxygenation (ECMO) for a 40-year-old woman with a history of severe left ventricular dysfunction who presented for elective dilation and evacuation of triplets at 20 weeks' gestation. The patient's medical history was significant for hypertension, diabetes mellitus, methamphetamine use (acute/chronic), and cardiac-respiratory arrest before her previous emergent cesarean delivery. The patient underwent general anesthesia with the placement of peripheral venous and arterial cannulas for "stand-by" ECMO. The patient remained stable throughout the procedure, and "stand-by" ECMO was not initiated; the patient was discharged 5 days' postprocedure. The use of "stand-by" ECMO in the parturient with severe cardiopulmonary dysfunction is still in its infancy. Centers managing populations of both high-risk parturients and nonparturients may consider development of algorithms for implementation and utilization of ECMO.
authors.affiliation: From the *Department of Anesthesiology, Brigham and Women's Hospital, Boston, Massachusetts; †Department of Anesthesiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California; ‡Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California; §Department of Surgery, Division of Cardiac Surgery, The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; ‖Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, Michigan; and ¶Department of Obstetrics, University of California, Irvine Medical Center, Irvine, California.
authors.forename: Cesar
authors.initials: C
authors.lastname: Padilla
authors.forename: Antonio
authors.initials: A
authors.lastname: Hernandez Conte
authors.forename: Danny
authors.initials: D
authors.lastname: Ramzy
authors.forename: Lorraine
authors.initials: L
authors.lastname: Lubin
authors.forename: Troy
authors.initials: T
authors.lastname: LaBounty
authors.forename: Judith H
authors.initials: JH
authors.lastname: Chung
authors.forename: Ying
authors.initials: Y
authors.lastname: Zeng
mesh_terms: D000032:Abortion, Therapeutic / Q000379:methods*; D000328:Adult; D009202:Cardiomyopathies / Q000139:chemically induced / Q000628:therapy*; D000697:Central Nervous System Stimulants / Q000009:adverse effects; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D008694:Methamphetamine / Q000009:adverse effects; D009767:Obesity, Morbid / Q000150:complications; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000628:therapy*; D059286:Pregnancy, Triplet; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced / Q000628:therapy*
chemical_list: D000697:Central Nervous System Stimulants; D008694:Methamphetamine