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Pregnancy-associated extracorporeal life support: insights from a nationwide dual-cohort analysis
Feng-Cheng Chang1, Yu-Ting Cheng2, Ming-Jer Hsieh3
1Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan.
Background:
Extracorporeal life support (ECLS) is used as rescue therapy for refractory cardiopulmonary failure. Population-level evidence on prognosis and long-term sequelae in patients requiring ECLS during pregnancy or the peripartum period remains limited.
Methods:
We performed a nationwide retrospective dual-cohort study using linked Taiwanese databases (2001-22). In the delivery cohort, 247 ECLS pregnancies were compared with 3 970 948 non-ECLS pregnancies. In the ECLS cohort, 247 pregnancy-associated ECLS cases were compared with 2112 non-pregnant women of reproductive age receiving ECLS. Outcomes included 42-day maternal mortality and complications, neonatal outcomes, and long-term maternal outcomes beyond 42 days postpartum.
Results:
The incidence of pregnancy-associated ECLS was 6.2 per 100 000 deliveries and increased over time (P trend <0.001). Leading indications were amniotic fluid embolism (26.7%), peripartum cardiomyopathy (18.6%), and respiratory failure (12.6%), with highest mortality in obstetric indications. Maternal mortality at 42 days was 41.3%, with renal failure (36.4%), major bleeding (11.3%) and stroke (10.9%) as major morbidities. Neonates had higher risks of preterm birth, low birth weight, and major morbidity. Beyond 42 days postpartum, ECLS-exposed pregnant patients had higher all-cause mortality (adjusted hazard ratio [aHR] 28.0, 95% confidence interval [CI] 16.8-46.8), cardiovascular mortality, permanent dialysis, and psychiatric disorders. In the ECLS cohort, pregnancy-associated ECLS had lower in-hospital mortality (43.7% vs 53.8%) and better long-term survival (aHR 0.42, 95% CI 0.23-0.78) than nonpregnant recipients.
Conclusions:
Pregnancy-associated ECLS is rare but is increasing in incidence, and identifies a clinically high-risk population with substantial early maternal and neonatal risk. Multidisciplinary follow-up is required for survivors of pregnancy-associated ECLS in view of their ongoing risk of long-term cardiovascular, renal, and psychiatric sequelae.