This study reviewed data from the ELSO registry on 44 patients who received extracorporeal membrane oxygenation (ECMO) for peripartum cardiomyopathy (PPCM) between 2007-2016. Overall survival to discharge was 56.8% and 75% were weaned off ECMO. Higher pre-ECMO ventilation rates and use of vasopressors/inotropes were associated with decreased survival, as was ECMO cannula site bleeding. The study concludes ECMO can be a viable option for PPCM patients when clinically indicated based on the survival rates observed.

1. Extracorporeal Membrane Oxygenation in Peripartum Cardiomyopathy – a review of the ELSO Registry
1 Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA, 2 Cardiothoracic ICU, National University Hospital, Singapore,
3 Cardio-Thoracic Department, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands,
4 Paediatric ICU, Royal Children's Hospital, University of Melbourne, Melbourne, Australia, 5 Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA
Olson TL1, Ramanathan KR2, Lorusso R3, MacLaren G4, and Anders MM5
Background
Peripartum cardiomyopathy (PPCM) is an idiopathic
cardiomyopathy characterized by heart failure secondary
to left ventricular systolic dysfunction, typically with an
ejection fraction <45%, occurring towards the end of
pregnancy or in the months following delivery for which no
other cause of heart failure is found.1 Rarely, catastrophic
presentations can occur with severe respiratory distress
and low cardiac output necessitating mechanical
ventilation and circulatory support. Data on the use of
extracorporeal membrane oxygenation (ECMO) in PPCM is
limited. Little is known about the safety, efficacy, or
mortality. The Extracorporeal Life Support Organization
(ELSO) maintains an international registry of patients
treated with ECMO since 1989 and collects data from over
300 pediatric and adult centers. We sought to examine the
ELSO registry for PPCM patients treated with ECMO in
order to characterize demographic and clinical features,
complications, overall survival to discharge, and variables
associated with mortality.
Methods
This study was a retrospective review of patients
voluntarily entered into the ELSO registry by participating
centers. De-identified data was collected on patients with a
diagnosis of PPCM based on ICD-9/ICD-10 coding who
received ECMO between 2007 and 2016. Our primary
outcome measure was survival to hospital discharge. We
also collected data on demographics, pre-ECMO ventilation
and biochemical parameters, ECMO mode, duration and
complications. Categorical and dichotomous variables are
expressed as exact numbers with percentages, whereas
continuous variables are expressed as median with 25th-
75th interquartile ranges (IQR). Initial bivariate analyses
assessed potential association between survival and
ECMO-related variables. We used Fischer’s exact,
Pearson’s chi-square, and logistic regression. Statistical
analyses were carried out using JMP®.
1. Sliwa K, Hilfiker-Kleiner D, Petrie MC, Mebazaa A, Pieske B, Buchmann E, Regitz-Zagrosek
V, Schaufelberger M, Tavazzi L, van Veldhuisen DJ, Watkins H, Shah AJ, Seferovic PM,
Elkayam U, Pankuweit S, Papp Z, Mouquet F, McMurray JJ. Current state of knowledge
on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a
position statement from the Heart Failure Association of the European Society of
Cardiology Working Group on peripartum cardiomyopathy. Eur J Heart Fail. 2010
Aug;12(8):767-78.
PRE-ECMO PARAMETERS AND SUPPORT
DEMOGRAPHICS AND ECMO COURSE COMPLICATIONS RESULTS & CONCLUSION
REFERENCE
• Author Contact: tolson@bcm.edu
46 patients met inclusion criteria. 2 patients were excluded
leaving 44 patients for the analysis. Overall survival to
discharge was 56.8% while 75.0% of patients were weaned
off ECMO. All patients had one ECMO run except for one
patient who had two. All patients were conventionally
ventilated.
Cardiovascular (52.3%), renal (36.4%), hemorrhagic
(34.1%), mechanical (25.0%), infectious (15.9%), metabolic
(15.9%), neurologic (11.4%), and pulmonary (9.1%)
complications were reported.
Pre- ECMO variables associated with decreased survival
included higher ventilation rate (p=0.03**, OR 0.88 [0.79-
0.98]) and support with vasopressor or inotropic agents
(p<0.01, OR 0.09 [0.01-0.82]). Decreased survival was also
observed in patients with ECMO cannula site bleeding
(p=0.02, OR 0.14 [0.02-0.83]).
Our review is the largest to date of PPCM patients
supported with ECMO. We identified factors associated
with mortality including pre-ECMO ventilation rate, pre-
ECMO support with vasopressors, and ECMO cannula site
bleeding. We believe our data supports the use of ECMO
in PPCM when clinically indicated.
ALL
N=44
SURVIVORS
N=25
NON-SURVIVORS
N=19
p
Age in years
Median (IQR)
30.0 (25.0-35.1) 31.8 (26.1-35.5) 25.7 (23.8-35.0) 0.33
Weight in kg
Median (IQR)
80.6 (65.0-93.0) 81.0 (67.0-94.0) 72.0 (64.5-93.0) 0.75
Duration ECMO in
hours
Median (IQR)
182 (90-238) 185 (106-212) 163 (35-318) 0.42
Cardiac Support
N (%)
32 (72.7%) 21 (84.0%) 11 (57.9%) 0.09
Respiratory Support
N (%)
5 (11.4%) 2 (8.0%) 3 (15.8) 0.64
ECPR
N (%)
7 (15.9%) 2 (8.0%) 5 (26.3%) 0.21
VA Mode
N (%)
38 (86.4%) 21 (84.0%) 17 (89.5%) 0.66
VV Mode
N (%)
5 (11.4%) 3 (12.0%) 2 (10.5%) 0.66
COMPLICATION
ALL
N (%)
SURVIVORS
N (%)
NON-
SURVIVORS
N (%)
p
Any cardiac 23 (52.3%) 15 (60.0%) 8 (42.1%) 0.24
Cardiac arrhythmia 6 (13.6%) 2 (8.0%) 4 (21.1%) 0.23
Inotropes on ECMO 22 (50.0%) 15 (60.0%) 7 (36.8%) 0.06
Any hemorrhagic 15 (34.1%) 5 (20.0%) 10 (52.6%)
0.02
OR 0.22
[0.06-0.85]
Cannula site
bleeding
9 (20.5%) 2 (8.0%) 7 (36.8%)
0.02
OR 0.14
[0.02-0.83]
Any infectious 7 (15.9%) 4 (16.0%) 3 (15.8%) 0.98
Limb ischemia 1 (2.3%) 1 (4.0%) 0 0.36
Any mechanical 11 (25.0%) 7 (28.0%) 4 (21.1%) 0.60
Any metabolic 7 (15.9%) 4 (16.0%) 3 (15.8%) 0.98
Hyperbilirubinemia 4 (9.1%) 1 (4.0%) 3 (15.8%) 0.19
pH <7.2 1 (2.3%) 1 (4.0%) 0 0.36
Any neurologic 5 (11.4%) 1 (4.0%) 4 (21.1%) 0.07
Any pulmonary 4 (9.1%) 3 (12.0%) 1 (5.3%) 0.44
Pneumothorax 3 (6.8%) 2 (8.0%) 1 (5.3%) 0.69
Pulmonary
hemorrhage
2 (4.5%) 2 (8.0%) 0 0.19
Any renal 16 (36.4%) 11 (44.0%) 5 (26.3%) 0.23
ALL SURVIVORS NON-SURVIVORS p
Ventilator rate
Median (IQR)
18 (14-30) 16 (13-20) 26 (15-33)
0.03
OR 0.88
[0.79-0.98]
Mean airway
pressure (cmH20)
Median (IQR)
15 (12-22) 16 (12-20) 13 (8-28) 0.85
FiO2
Median (IQR)
100 (75-100) 100 (55-100) 100 (100-100) 0.14
pH
Median (IQR)
7.33 (7.17-7.43) 7.38 (7.17-7.43) 7.24 (7.10-7.46) 0.48
Bicarbonate
Median (IQR)
19.9 (13.3-23.0) 20.4 (15.9-23.2) 18.8 (11.6-22.4) 0.18
Mean arterial blood
pressure (mmHg)
Median (IQR)
65 (52-78) 62 (47-74) 71 [52-78] 0.84
Intra-aortic balloon
pump
N (%)
11 (25.0%) 9 (36.0%) 2 (10.5%) 0.15
Vasopressor/
Inotrope therapy
N (%)
29 (65.9%) 14 (56.0%) 15 (78.9%)
<0.01
OR 0.09
[0.01-0.82]
CONCLUSION