Table 3.
Maternal and newborn outcomes of critically ill women with refractory ARDS rescued by ECMO according to their pregnancy status on ECMO
| All (N = 24) | Ongoing pregnancy on ECMO (N = 11) | Delivery before ECMO (N = 13) | p | |
|---|---|---|---|---|
| Maternal outcomes | ||||
| Delivery procedures | ||||
| C-section | 15 (63) | 3 (27) | 12 (92) | < 0.01 |
| Vaginal delivery | 4 (17) | 4 (36) | 0 (0) | 0.02 |
| In-ICU expulsion* | 5 (21) | 4 (36) | 1 (8) | 0.13 |
| General anesthesia or ICU sedation | 18 (75) | 8 (73) | 10 (77) | 0.81 |
| Epidural anesthesia | 6 (25) | 3 (27) | 3 (23) | 0.81 |
| ECMO duration, days | 20 (3–95) | 20 (3–95) | 33 (5–71) | 0.04 |
| In survivors | 26 (5–95) | 25 (5–95) | 27 (5–52) | 0.24 |
| Mechanical ventilation duration, days | 42 (3–116) | 37 (3–116) | 47 (8–89) | 0.47 |
| In survivors | 41 (8–116) | 41 (9–116) | 40 (8–71) | 0.96 |
| ICU length of stay, days | 48 (7–120) | 42 (7–120) | 53 (16–115) | 0.25 |
| In survivors | 46 (14–120) | 46 (14–120) | 45 (14–74) | 0.92 |
| ICU discharge survival | 21 (88) | 9 (82) | 12 (92) | 0.44 |
| Hospital discharge survival | 19 (79) | 8 (73) | 11 (85) | 0.47 |
| Long-term maternal outcomes£ | ||||
| Time from ICU discharge to evaluation, months | 61 (4–172) | 56 (4–145) | 65 (9–192) | 0.76 |
| Returned to work££ | 4 (25) | 2 (29) | 2 (22) | 1 |
| IES revised score | 30 (12–51) | 29 (12–51) | 31 (12–49) | 0.91 |
| PTSD** | 6 (38) | 3 (43) | 3 (33) | 0.70 |
| Other pregnancies | 7 (44) | 4 (57) | 3 (33) | 0.34 |
| Newborn outcomes | ||||
| Estimated fetus weight at ECMO onset, g | – | 828 (250–1390) | – | – |
| Birth term, weeks | 33 (23–39) | 31 (23–38) | 34 (25–39) | 0.47 |
| Alive at birth | 18 (75) | 6 (55) | 12 (92) | 0.03 |
| Alive on Day 1 post-delivery | 16 (67) | 5 (45) | 11 (85) | 0.04 |
| Birth weight, g | 2157 (500–4000) | 1733 (500–2750) | 2580 (600–4000) | 0.14 |
| Stay in neonatal ICU | 7 (39) | 2 (33) | 5 (42) | 0.35 |
| Severe preterm morbidity in survivors*** | 0 (0) | 0 (0) | 0 (0) | 1 |
| Healthy child at the time of follow-up | 16 (67) | 5 (45) | 11 (85) | 0.04 |
Data are expressed as n (%) or median (range)
ECMO extracorporeal membrane oxygenation; ARDS acute respiratory distress syndrome; ICU intensive care unit; IES Impact of Event Scales; PTSD post-traumatic stress disorder
*Spontaneous in-ICU expulsion on ECMO in the ongoing pregnancy group or expulsion before ECMO onset in the “delivery before ECMO” group with 1 fetal loss due to medical termination of the pregnancy for maternal rescue purposes at 17 weeks of gestation
**Score ≥ 33 at the revised Impact of Event Scale (IES-r) being compatible with a probable diagnosis of PTSD
***Intraventricular hemorrhage, bronchopulmonary dysplasia, necrotizing enterocolitis, retinopathy, cerebral palsy
£Phone call interview was performed on 7 survivors from the “ongoing pregnancy on ECMO” group and 9 survivors from the “delivery before ECMO” group
££Respectively, 1 in 7 and 2 in 9 survival women in the “ongoing pregnancy on ECMO” and “delivery before ECMO” groups did not work before hospitalization