ECMO in pregnant and non pregnancy women TOG 2023 Flashcards
When is ECMO used
Advanced life support for selected patients with severe cardio and respiratory compromise when convention treatments failed
What is the basic principle of ECMO?
Drain deoxygenated blood from the body removed CO2 and replace O2 and return the oxygenated blood to either the venous or arterial systems.
Difference between Veno-arterial and venous-veno ECMO?
Veno-venous - Drained and returned to a vein, supporting gas exchanged of lung - respiratory causes
Venn-arterial - drained from vein returned to artery supporting CV and respiratory systems.
When is ECMO considered in terms of mortality risk?
Considered is estimated mortality is >50%
Indicated if estimated mortality >80%
Cardiac and respiratory causes of ECMO
Contraindications for ECMO
Which infections more severe in pregnancy patients vs non pregnanct
COVID-19
H1N1 Influenza
Varicella Zoster
Group A Strep
Pneumococcus
What is the most common cause of repiratory ECMO?
ARDS
- In pregnancy can be caused by severe PET, AFE, severe sepsis and MOH
What is most common cardiac indication for ECMO?
PE
More common in pregnancy & PP.
2nd Cardiac failure - e.g. peripartum cardiomyopathy
Most common complication on ECMO?
Bleeding
ECMO induced coagulaopthy
ICH 1.2% (V-A) 2.7% (V-V)
If on ECMO is prone position or L lateral tilt recommend if patient remains pregnant
Prone position & advanced ventilation strategies less impact; as ECMO supports gas exchanged
L lateral tilting recommending to reduce aortocarval return
If delivery required on ECMO for how long before the delivery can anticoagulation be stopped?
Can stop the anticoagulation for 6 hours withthout complication, normaly delivered by CS
Overall what % of ECMO cases survived to discharge
What are the survival rates in pregnancy/postpartum
18%
> 75% in pregnancy population
Fetal survival in ECMO supported mothers
65-70%
Can breastfeeding occur on ECMO?
If no contraindications in terms of medication being given
