Extracorporeal membrane oxygenation during pregnancy and peripartal. An international retrospective multicenter study

INTRODUCTION

Extracorporeal Membrane Oxygenation (ECMO) may be used in the setting of pregnancy or the peripartal period, however its utility has not been well-characterized. This study aims to give an overview on the prevalence of peripartel ECMO cases and further assess the indications and outcomes of ECMO in this setting across multiple centers and countries.

METHODS

A retrospective, multicenter, international cohort study of pregnant and peripartum ECMO cases was performed. Data were collected from six ECMO centers across three continents over a 10-year period.

RESULTS

A total of 60 pregnany/peripartal ECMO cases have been identified. Most frequent indications are acute respiratory distress syndrome (n = 30) and pulmonary embolism (n = 5). Veno-venous ECMO mode was applied more often (77%). ECMO treatment during pregnancy was performed in 17 cases. Maternal and fetal survival was high with 87% (n = 52), respectively 73% (n = 44).

CONCLUSIONS

Various emergency scenarios during pregnancy and at time of delivery may require ECMO treatment. Peripartal mortality in a well-resourced setting is rare, however emergencies in the labor room occur and knowledge of available rescue therapy is essential to improve outcome. Obstetricians and obstetric anesthesiologists should be aware of the availability of ECMO resource at their hospital or region to ensure immediate contact when needed.

P2791Method for detection of blood clots in ventricular assist devices

Background

The technical development of modern ventricular assist devices (VAD) shows continued improvement in patient outcome. VADs continue to gain increased use not only as bridge to transplant but also as a destination therapy. However, VAD therapy is associated with complications, among which thromboembolic complications are common. Better management for early detection is paramount to improve patient outcome.

Purpose

The aims of this study were to determine if the VADs under consideration may retain clots, and to assess the feasibility of early clot detection using a non-invasive technique.

Methods

Two different VADs, the HeartMate II (HMII) and HeartMate 3 (HM3) were tested in a mock loop. Clot analogs (2 cm yarn fragments) were introduced into the loop upstream to the pump. Sound and vibration of the pump was measured using two hydrophones and at the inflow and outflow of the VAD (frequency range: 0.1Hz to 180kHz). The acoustic/vibration data was analyzed concerning the spectral content.

Results

The flow at the outflow section contained a low frequency swirling component. This appeared to be the basic flow feature. However, in the presence of clot analogs, the frequency signal was amplified. For the HMII this occurred below 10Hz. Concerning the HM3 this signal was more difficult to analyze due to HM3's non-constant rotational speed. However, by using wavelet filtering, it was possible to detect the low frequency signal in the presence of clot analogs. It was also observed that clot analogs tended to accumulate at certain regions in the respective VAD. In the HM3, clot fragments remained in a stagnation region at the bottom pump. This experimental finding contradicts published washout results based on a passive scalar model.

Conclusions

These mock loop results indicated the feasibility of early detection of blood clots in VADs by analysis of the sound/vibration induced by the clot. The signal “finger-print” needed for detection may also be possible to recover under non-continuous operational rotational speed as in the HM 3.

Management strategies in venovenous extracorporeal membrane oxygenation: a retrospective comparison from five European centres

OBJECTIVE

To investigate contemporary clinical practice in the management of venovenous (VV) extracorporeal membrane oxygenation (ECMO) in critically ill patients with bacterial pneumonia.

METHODS

In this multicentre retrospective study, 48 patients with severe respiratory failure due to bacterial pneumonia receiving VV ECMO therapy in five experienced European ECMO centres were included. Ventilator and ECMO settings were analysed.

RESULTS

Ventilator settings showed great variability between participating centres, particularly relating to positive end-expiratory pressure, peak inspiratory pressure and driving pressure. Different strategies in cannulation, ECMO setting and weaning procedures were also observed.

CONCLUSION

There is great diversity in management modalities for ventilator and ECMO settings for patients with bacterial pneumonia. Our study emphasises the lack of clinical consensus in VV ECMO management.