Extracorporeal life support during pregnancy
Extracorporeal life support during pregnancy
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DOI：
10.1016/j.jtcvs.2015.12.027
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发表时间：
2016-04-01
影响因子：
6
通讯作者：
Coleman, Denise M.
中科院分区：
文献类型：
--
作者：
Moore, Sarah A.;Dietl, Charles A.;Coleman, Denise M.
目的：回顾妊娠期间体外生命支持 (ECLS) 的文献，以确定其对母亲和胎儿的有效性和安全性。方法：使用以下搜索查询从 MEDLINE、PubMed.gov 和 ScienceDirect.com 获得全面的文献检索：ECLS 和妊娠、体外膜氧合 (ECMO) 和妊娠、ECMO 和 H1N1 流感、急性呼吸窘迫综合征 (ARDS) 和妊娠、妊娠和 H1N1 流感以及体外生命支持组织注册表。结果：我们的文献检索产生了 332 篇文章供综述。 26 篇出版物报道了总共 45 名患者在怀孕期间接受 ECLS 或 ECMO 治疗。产后患者不包括在内。 ECLS 的适应症为严重 H1N1 流感伴 ARDS (n = 33)、其他 ARDS (n = 8)、心源性休克 (n = 3) 和心脏骤停 (n = 1)。平均胎龄为 26.5 周（范围，12-38 周），ECLS 的中位持续时间为 12.2 天（范围，1-57 天）。母亲的存活率为 77.8%（45 名中的 35 名），胎儿的存活率为 65.1%（43 名中的 28 名）。此外，我们报告了一名 25 岁孕妇，患有汉坦病毒心肺综合征，对升压药和正性肌力药无反应。患者接受静脉动脉ECMO治疗72小时，康复后无并发症，并产下健康婴儿。母子6年后仍无症状。结论：妊娠期ECLS对母亲和胎儿有效且相对安全。 ECLS 首次在患有危及生命的汉坦病毒心肺综合征的妊娠患者中成功使用，与本综述一起进行了报道。
Objectives: To review the literature on extracorporeal life support (ECLS) during pregnancy to determine its efficacy and safety for the mother and fetus.Methods: A comprehensive literature search was obtained from MEDLINE via PubMed.gov and from ScienceDirect.com using the following search queries: ECLS and pregnancy, extracorporeal membrane oxygenation (ECMO) and pregnancy, ECMO and H1N1 influenza, acute respiratory distress syndrome (ARDS) and pregnancy, pregnancy and H1N1 influenza, and Extracorporeal Life Support Organization registry.Results: Our literature search produced 332 articles for review. A total of 45 patients treated with ECLS or ECMO during pregnancy were reported in 26 publications. Postpartum patients were not included. Indications for ECLS were severe H1N1 influenza with ARDS (n = 33), other ARDS (n = 8), cardiogenic shock (n = 3), and cardiac arrest (n = 1). The mean gestational age was 26.5 weeks (range, 12-38 weeks), and the median duration of ECLS was 12.2 days (range, 1-57 days). The survival rate was 77.8% (35 of 45) for mothers and 65.1% (28 of 43) for fetuses. In addition, we report a 25-year-old pregnant patient with hantavirus cardiopulmonary syndrome unresponsive to pressors and inotropes. The patient was placed on venoarterial ECMO for 72 hours, recovered without complications, and delivered a healthy infant. The mother and son remain asymptomatic 6 years later.Conclusions: ECLS during pregnancy is effective and relatively safe for the mother and fetus. The first successful use of ECLS in a pregnant patient with life-threatening hantavirus cardiopulmonary syndrome is being reported together with this review.