TY - JOUR
T1 - Pregnancy-Associated Extracorporeal Membrane Oxygenation in the United States
AU - Varvoutis, Megan S.
AU - Wein, Lauren E.
AU - Sugrue, Ronan
AU - Darwin, Kristin C.
AU - Vaught, Arthur J.
AU - Meng, Marie Louise
AU - Hughes, Brenna L.
AU - Grotegut, Chad A.
AU - Federspiel, Jerome J.
N1 - Funding Information:
The authors appreciate the HCUP Data Partners who contribute data to the NRD. A complete list of partners can be found at ( www.hcup-us.ahrq.gov/hcupdatapartners.jsp ). Work contained in this manuscript were made possible by the following grants from the National Institutes of Health (TL1-TR002555 [J.J.F.]). Data acquisition was also supported by funding from the Foundation for Women and Girls with Blood Disorders to J.J.F.
Funding Information:
J.J.F. is supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number: UL1TR002553. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Data acquisition for this project was supported by grant funding for the Foundation for Women and Girls with Blood Disorders.
Publisher Copyright:
© 2023 Thieme Medical Publishers, Inc.. All rights reserved.
PY - 2023
Y1 - 2023
N2 - 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.
AB - 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.
KW - extracorporeal membrane oxygenation
KW - heart failure
KW - pregnancy
KW - respiratory failure
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U2 - 10.1055/a-2008-8462
DO - 10.1055/a-2008-8462
M3 - Article
C2 - 36608702
AN - SCOPUS:85159329778
SN - 0735-1631
JO - American journal of perinatology
JF - American journal of perinatology
ER -