Extracorporeal membrane oxygenation in peripartum cardiomyopathy: A review of the ELSO Registry

Aims: Data on the use of extracorporeal membrane oxygenation (ECMO) for cardiogenic shock in peripartumcardiomyopathy (PPCM) is limited. We queried the Extracorporeal Life Support Organization (ELSO) Registry for PPCMpatients treatedwith ECMO in order to characterize demographic and clinical features, complications, survival, and variables associated with mortality.

Methods and results: This was a retrospective review of patients voluntarily entered into the ELSO Registry. Deidentified data was collected on patients with a diagnosis of PPCM based on ICD-9/ICD-10 coding who received ECMO between 2007 and 2019. Collected data included demographics, ECMOmode, cannulation strategies, preECMO ventilator, biochemical, and hemodynamic parameters, run duration, complications, and survival towean off ECMO and hospital discharge. Our primary outcome measure was survival to discharge. In the final analysis, 88 veno-arterial (VA) ECMO patients were included. Overall, 72% of patients were weaned off ECMO, including 10% who were weaned to ventricular assist device or heart transplantation, and 64% survived to hospital discharge. Extracorporeal cardiopulmonary resuscitation (ECPR) was performed in 11% of patients with 60% survival. Factors associated with decreased survival included neurologic complications (p = 0.03), specifically central nervous system hemorrhage (p= 0.01).

Conclusion: Our review is the largest to date of PPCM patients supported with VA ECMO for cardiogenic shock. ECMO and ECPR are valuable forms of short-termmechanical circulatory support with acceptable mortality profiles for PPCMpatients who remain refractory to aggressive medicalmanagement. Complications should be meticulously avoided, especially neurologic complications. (c) 2020 Elsevier B.V. All rights reserved.