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Utilization, outcomes, and costs of extracorporeal membrane oxygenation among pregnant women in the United States, 1999-2014.
Abstract Number: T1B-159
Abstract Type: Original Research
Despite its life-saving potential in leading causes of maternal mortality (1) utilization of extracorporeal membrane oxygenation (ECMO) in obstetric patients remains uncommon (2). Evidence for its efficacy and safety in pregnancy is scarce. The aim of this study was to analyze ECMO utilization, costs and outcomes in obstetric patients in the United States.
Data were obtained from the National Inpatient Sample 1999-2014, a 20% representative sample of discharge records. ECMO was identified using the ICD-9-CM code 39.65. Pregnancy and ECMO complications were identified using ICD-9-CM algorithm. Indication for ECMO was identified by analysis of ICD-9-CM codes in individual discharge records. Hospital costs were calculated and expressed in constant $2014. Trends were tested using adjusted weighted logistic regression.
During the study period 20,454 adult (>15 years old) ECMO cases were identified of which 331 were pregnant women (1.6%). ECMO utilization during pregnancy increased from 1.2 per million deliveries in 1999-2002 to 12.4 in 2011-2014 (P < 0.001), with isolated cardiogenic shock as the most common indication (49.5%). Most common conditions associated with ECMO use were sepsis, cardiomyopathy, and aspiration pneumonia with marked differences in mortality and hospital costs depending on the condition (Table). Mortality rates decreased over time in both cohorts but to a greater extent in the pregnant cohort (-57% vs -21% in the general adult cohort; Figure 1A), but with similar median hospital costs ($146,706 vs $170,451, respectively; P = 0.69; Figure 1B). There was no difference in rates of thrombotic or hemorrhagic complications between the cohorts.
We identified for the first time that ECMO utilization in pregnancy is associated with reduced mortality than in the general adult population, without increased risk for hemorrhagic or thromboembolic complications. The association between aspiration pneumonia after cesarean delivery and ECMO warrants further evaluation, as this was not an expected finding. Our analysis suggests that ECMO is an effective intervention in the setting of acute maternal conditions, particularly for women with influenza, myocardial infarction, and aspiration pneumonia in which mortality rates were very low.
1. Obstet Gynecol 2017;130,366-37
2. Semin Perinatol 2018;42:21-2