Abstract 17650: Outcomes Of Critically Ill Peripartum Cardiomyopathy Treated With Extracorporeal Membrane Oxygenation
Introduction: Severe refractory cardiogenic shock (SRCS) has in-hospital mortality approaching 60-80%. Treatment of SRCS with temporary circulatory support options such as peripheral ventricular assist devices and extracorporeal membrane oxygenation(ECMO) has been reported with varying success.
Peripartum cardiomyopathy is a type of non-ischemic cardiomyopathy that occurs in previously healthy women in the final month of pregnancy and up to 5 months after delivery. Individual case reports of the use of ECMO in this patient cohort have been reported. As a group, peripartum cardiomyopathy patients are young with few co-morbidities and might benefit from ECMO to bridge them to myocardial recovery, durable ventricular assist device (VAD), or orthotopic heart transplant (OHT).
Methods: This is a retrospective review of the largest case series of female patients with peripartum cardiomyopathy who were supported with ECMO at the Hospital of the University of Pennsylvania from August 2009 to March 2013. Data was gathered retrospectively from prospectively entered clinical databases.
Results: From August 2009 to March 2013, 10 female patients required ECMO for cardiac arrest and progressive severe refractory cardiogenic shock. 80% of patients had a cardiac arrest at time of ECMO initiation. The mean age of the cohort at presentation was 27.6 ± 6.26 years old, with 50% being African-American. Mean length of support of ECMO was 6.7 ± 4.34 days. The mean ejection fraction on initial presentation was 12.5 ± 8.5%. ECMO was successful in all 10 patients at bridging to VAD then OHT (n= 1), VAD (n= 4) or recovery (n= 5). The overall in-hospital survival was 80% (8/10). From the four durable VAD patients, one device has been explanted after myocardial recovery. The two patient deaths were in patients who received subsequent VAD support but still had refractory shock resulting in multisystem organ failure.
Conclusions: In peripartum cardiomyopathy patients with severe refractory cardiogenic shock, ECMO is an efficacious option as a bridge to recovery, transplant or LVAD.
- © 2013 by American Heart Association, Inc.