Varvoutis Megan S, Wein Lauren E, Sugrue Ronan, Darwin Kristin C, Vaught Arthur J, Meng Marie-Louise, Hughes Brenna L, Grotegut Chad A, Federspiel Jerome J
Department of Obstetrics and Gynecology, West Virginia University, Morgantown, West Virginia.
Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina.
Am J Perinatol. 2024 May;41(S 01):e1248-e1256. doi: 10.1055/a-2008-8462. Epub 2023 Jan 6.
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.
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.
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.
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.
· 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..
体外膜肺氧合（ECMO）疗法在成年人群中的应用有所增加。甲型H1N1流感大流行期间的研究表明，孕期使用ECMO与良好结局相关。随着受2019冠状病毒病（COVID-19）影响且可能需要这种挽救生命疗法的孕妇数量不断增加，我们试图比较育龄女性患者中与妊娠相关和与非妊娠相关的ECMO治疗在合并症、成本和结局方面的差异。
我们使用了2013年至2019年国家再入院数据库。通过诊断和程序编码来确定ECMO的使用情况、潜在适应症、合并症和妊娠结局。主要结局是患者首次接受ECMO治疗期间的住院死亡率。次要结局包括住院时间和住院费用、ECMO住院期间血栓栓塞或出血并发症的发生情况，以及ECMO治疗后330天内的死亡率和再入院情况。使用单变量和多变量回归模型来模拟妊娠状态与结局之间的关联。
样本包括324例与妊娠相关的住院病例和3805例与非妊娠相关的住院病例，分别对应研究期间全国估计的665例和7653例。与妊娠相关的ECMO治疗的住院死亡率（调整优势比[aOR]：0.56，95%置信区间[CI]：0.41 - 0.75）和出血并发症发生率（aOR：0.67，95% CI：0.49 - 0.93）较低。住院时间显著缩短（调整率比[aRR]：0.86，95% CI：0.77 - 0.96），总住院费用也较低（aRR：0.83，95% CI：0.75 - 0.93）。血栓栓塞事件发生率的差异（aOR：1.04，95% CI：0.78 - 1.38）无统计学意义。
与非妊娠相关的ECMO治疗相比，与妊娠相关的ECMO治疗的住院死亡率、出血并发症、总住院费用和住院时间较低，且血栓栓塞并发症未增加。应向符合条件的患者提供与妊娠相关的ECMO治疗。
· 将与妊娠相关的ECMO使用情况与非妊娠相关的使用情况进行了比较。· 结局与妊娠相关的应用相当或更有利。· 在考虑孕期使用ECMO时，这些数据可能会有所帮助。
