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Utilization and Outcomes of Extracorporeal Membrane Oxygenation in Obstetric Patients in the United States, 1999–2014: A Retrospective Cross-Sectional Study
Anesthesia & Analgesia ( IF 5.7 ) Pub Date : 2022-08-01 , DOI: 10.1213/ane.0000000000005753
Bushra Taha 1 , Jean Guglielminotti 1 , Guohua Li 1, 2 , Ruth Landau 1
Affiliation  

BACKGROUND: 

Utilization of extracorporeal membrane oxygenation (ECMO) for adult critically ill patients is increasing, but data in obstetric cohorts are scant. This study analyzed ECMO utilization and maternal outcomes in obstetric patients in the United States.

METHODS: 

Data were abstracted from the 1999–2014 National Inpatient Sample (NIS), a 20% US national representative sample. ECMO hospitalizations (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 39.65) in patients ≥15 years of age were categorized into obstetric ECMO and nonobstetric ECMO. Obstetric patients included 4 categories: (1) loss or termination of pregnancy, (2) delivery (term or preterm), (3) postdelivery hospitalization, and (4) pregnancy without an obstetrical outcome. Possible underlying causes for obstetric ECMO were identified by analysis of ICD-9-CM codes in individual records. In-hospital death was abstracted from the NIS, and ECMO complications were identified using ICD-9-CM algorithms. Statistical significance in time-effect was assessed using weighted regression models.

RESULTS: 

During the 16-year study period, 20,454 adult ECMO cases were identified, of which 331 occurred in obstetric patients (1.6%; 95% confidence interval [CI], 1.4–1.8). Obstetric ECMO utilization rate was 4.7 per million obstetric discharges (95% CI, 4.2–5.2). The top 3 possible indications were sepsis (22.1%), cardiomyopathy (16.6%), and aspiration pneumonia (9.7%). Obstetric ECMO utilization rate increased significantly during the study period from 1.1 per million obstetric discharges in 1999–2002 (95% CI, 0.6–1.7) to 11.2 in 2011–2014 (95% CI, 9.6–12.9), corresponding to a 144.7% increase per 4-year period (95% CI, 115.3–178.1). Compared with nonobstetric ECMO, obstetric ECMO was associated with decreased in-hospital all-cause mortality (adjusted odds ratio [aOR] 0.78; 95% CI, 0.66–0.93). In-hospital all-cause mortality for obstetric ECMO decreased from 73.7% in 1999–2002 (95% CI, 48.8–90.8) to 31.9% in 2011–2014 (95% CI, 25.2–39.1), corresponding to a 26.1% decrease per 4-year period (95% CI, 10.1–39.3). Compared with nonobstetric ECMO, obstetric ECMO was associated with significantly increased risk of both venous thromboembolism without associated pulmonary embolism (aOR 1.83; 95% CI, 1.06–3.15) and of nontraumatic hemoperitoneum (aOR 4.32; 95% CI, 2.41–7.74).

CONCLUSIONS: 

During the study period, obstetric ECMO utilization has increased significantly and maternal prognosis improved.



中文翻译:

1999-2014 年美国产科患者体外膜氧合的应用和结果:一项回顾性横断面研究

背景: 

成人重症患者体外膜肺氧合 (ECMO) 的使用正在增加,但产科队列的数据很少。本研究分析了美国产科患者的 ECMO 使用情况和产妇结局。

方法: 

数据提取自 1999-2014 年全国住院患者样本 (NIS),这是一个 20% 的美国全国代表性样本。≥15 岁患者的 ECMO 住院治疗(国际疾病分类,第九版,临床修订版 [ICD-9-CM] 代码 39.65)分为产科 ECMO 和非产科 ECMO。产科患者包括 4 类:(1) 流产或终止妊娠,(2) 分娩(足月或早产),(3) 分娩后住院,和 (4) 没有产科结果的妊娠。通过分析个人记录中的 ICD-9-CM 代码,确定了产科 ECMO 可能的根本原因。从 NIS 中提取院内死亡,并使用 ICD-9-CM 算法确定 ECMO 并发症。使用加权回归模型评估时间效应的统计显着性。

结果: 

在 16 年的研究期间,确定了 20,454 例成人 ECMO 病例,其中 331 例发生在产科患者中(1.6%;95% 置信区间 [CI],1.4-1.8)。产科 ECMO 使用率为 4.7/百万产科出院(95% CI,4.2-5.2)。前 3 位可能的适应症是败血症 (22.1%)、心肌病 (16.6%) 和吸入性肺炎 (9.7%)。研究期间产科 ECMO 使用率显着增加,从 1999-2002 年的每百万产科出院率 1.1 (95% CI, 0.6-1.7) 增加到 2011-2014 年的 11.2 (95% CI, 9.6-12.9),相当于 144.7%每 4 年增加一次(95% CI,115.3–178.1)。与非产科 ECMO 相比,产科 ECMO 与院内全因死亡率降低相关(调整优势比 [aOR] 0.78;95% CI,0.66-0.93)。产科 ECMO 的院内全因死亡率从 1999-2002 年的 73.7%(95% CI,48.8-90.8)下降到 2011-2014 年的 31.9%(95% CI,25.2-39.1),相当于下降了 26.1%每 4 年期间 (95% CI, 10.1–39.3)。与非产科 ECMO 相比,产科 ECMO 与无相关肺栓塞的静脉血栓栓塞(aOR 1.83;95% CI,1.06-3.15)和非创伤性腹腔积血(aOR 4.32;95% CI,2.41-7.74)的风险显着增加相关。

结论: 

在研究期间,产科 ECMO 利用率显着提高,产妇预后得到改善。

更新日期:2022-07-18
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