Aims

Data on the use of extracorporeal membrane oxygenation (ECMO) for cardiogenic shock in peripartum cardiomyopathy (PPCM) is limited. We queried the Extracorporeal Life Support Organization (ELSO) Registry for PPCM patients treated with ECMO in order to characterize demographic and clinical features, complications, survival, and variables associated with mortality.

Methods and results

This was a retrospective review of patients voluntarily entered into the ELSO Registry. De-identified data was collected on patients with a diagnosis of PPCM based on ICD-9/ICD-10 coding who received ECMO between 2007 and 2019. Collected data included demographics, ECMO mode, cannulation strategies, pre-ECMO ventilator, biochemical, and hemodynamic parameters, run duration, complications, and survival to wean off ECMO and hospital discharge. Our primary outcome measure was survival to discharge. In the final analysis, 88 veno-arterial (VA) ECMO patients were included. Overall, 72% of patients were weaned off ECMO, including 10% who were weaned to ventricular assist device or heart transplantation, and 64% survived to hospital discharge. Extracorporeal cardiopulmonary resuscitation (ECPR) was performed in 11% of patients with 60% survival. Factors associated with decreased survival included neurologic complications (p = 0.03), specifically central nervous system hemorrhage (p = 0.01).

Conclusion

Our review is the largest to date of PPCM patients supported with VA ECMO for cardiogenic shock. ECMO and ECPR are valuable forms of short-term mechanical circulatory support with acceptable mortality profiles for PPCM patients who remain refractory to aggressive medical management. Complications should be meticulously avoided, especially neurologic complications.

中文翻译：

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围产期心肌病的体外膜氧合：ELSO注册中心的回顾。

目的

关于在围产期心肌病（PPCM）中使用体外膜氧合（ECMO）进行心源性休克的数据有限。我们询问了接受ECMO治疗的PPCM患者的体外生命支持组织（ELSO）注册中心，以表征人口统计学和临床​​特征，并发症，生存率以及与死亡率相关的变量。

方法与结果

这是对自愿加入ELSO注册中心的患者的回顾性回顾。根据2007年至2019年接受ECMO的，基于ICD-9 / ICD-10编码诊断为PPCM的患者的身份数据被收集。收集的数据包括人口统计学，ECMO模式，插管策略，ECMO前呼吸机，生化指标和血流动力学参数，运行持续时间，并发症和存活率，以脱离ECMO和出院。我们的主要结局指标是出院生存率。在最终分析中，包括了88名静脉-动脉（VA）ECMO患者。总体而言，有72％的患者断奶了ECMO，其中有10％的患者断奶了心室辅助设备或心脏移植，还有64％的患者幸存了出院的机会。11％生存率60％的患者进行了体外心肺复苏（ECPR）。p  = 0.03），特别是中枢神经系统出血（p  = 0.01）。

结论

我们的审查是迄今为止最大的接受VA ECMO支持的心源性休克的PPCM患者。ECMO和ECPR是短期机械循环支持的有价值的形式，对于仍难以接受积极医疗管理的PPCM患者，其死亡率可以接受。应谨慎避免并发症，尤其是神经系统并发症。