Use of Extracorporeal Membrane Oxygenation in Postpartum Management of a Patient with Pulmonary Arterial Hypertension

Memon, Humna Abid; Safdar, Zeenat; Goodarzi, Ahmad

doi:10.1155/2018/7031731

Cited by 4 publications

(3 citation statements)

References 22 publications

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“…ECMO is an advanced respiratory and circulatory support technology that has been proposed for patients with acute reversible respiratory failure ( 143 ). ECMO can maintain the oxygenation status of patients with PAH when cardiac function is decompensated ( 144 , 145 ). Various case reports suggested that ECMO treatment in the majority of pregnant women with PAH conferred favorable pregnancy outcomes ( 146 – 148 ).…”

Section: Treatmentmentioning

confidence: 99%

Management of pregnant patients with pulmonary arterial hypertension

Zhang

Huangfu²

2022

Front. Cardiovasc. Med.

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Pregnant individuals with pulmonary arterial hypertension (PAH) have significantly high risks of maternal and perinatal mortality. Profound changes in plasma volume, cardiac output and systemic vascular resistance can all increase the strain being placed on the right ventricle, leading to heart failure and cardiovascular collapse. Given the complex network of opposing physiological changes, strict contraception and reduction of hemodynamic fluctuations during pregnancy are important methods of minimizing the risk of maternal mortality and improving the outcomes following pregnancy. In this review, we discuss the recent research progress into pre-conception management and the various therapeutic strategies for pregnant individuals with PAH.

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Section: Treatmentmentioning

confidence: 99%

Management of pregnant patients with pulmonary arterial hypertension

Zhang

Huangfu²

2022

Front. Cardiovasc. Med.

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“…Although ECMO is one of the supporting procedures for recovery, time mostly being activated that was in postpartum period when refractory circulatory failure usually occurred. Several reports showed some benefits of ECMO during the peripartum stage [ 24 , 25 , 27 , 37 , 43 , 51 ]. Cannula size and route are also challenging for cannulation due to the anatomical changes during pregnancy.…”

Section: Critical Care Management Of Cardiac Decompensation In Pregna...mentioning

confidence: 99%

Critical care management of pulmonary arterial hypertension in pregnancy: the pre-, peri- and post-partum stages

et al. 2021

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The mortality rate of pulmonary hypertension in pregnancy is 25%–56%. Pulmonary arterial hypertension is the highest incidence among this group, especially in young women. Despite clear recommendation of pregnancy avoidance, certain groups of patients are initially diagnosed during the gestational age step into the third trimester. While the presence of right ventricular failure in early gestation is usually trivial, it can be more severe in the late trimester. Current evidence shows no consensus in the management and serious precautions for each stage of the pre-, peri- and post-partum periods of this specific group. Pulmonary hypertension-targeted drugs, mode of delivery, type of anesthesia, and some avoidances should be planned among a multidisciplinary team to enhance maternal and fetal survival opportunities. Sudden circulatory collapse from cardiac decompensation during the peri- and post-partum phases is detrimental, and mechanical support such as extracorporeal membrane oxygenation should be considered for mitigating hemodynamics and extending cardiac recovery time. Our review aims to explain the pathophysiology of pulmonary arterial hypertension and summarize the current evidence for critical management and precautions in each stage of pregnancy.

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“…Cardiopulmonary bypass can improve RV hemodynamics by unloading the pressure on RV, reducing pulmonary circulation pressures, and allowing for tight control of circulatory volumes to the mother and fetus [ 121 ]. Similarly, there are rare successful cases of veno-arterial ECMO use in the setting of right heart failure and hemodynamic collapse during pregnancy and delivery [ 122 , 123 , 124 ]. ECMO use is often limited by clinical trajectory, as it cannot be used indefinitely and generally serves as a bridge either to recovery or transplant.…”

Section: Introductionmentioning

confidence: 99%

Pregnancy Considerations in the Multidisciplinary Care of Patients with Pulmonary Arterial Hypertension

Coursen

Simpson

Mukherjee

et al. 2022

JCDD

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Pulmonary arterial hypertension (PAH) is a vasoconstrictive disease of the distal pulmonary vasculature resulting in adverse right heart remodeling. Pregnancy in PAH patients is associated with high maternal morbidity and mortality as well as neonatal and fetal complications. Pregnancy-associated changes in the cardiovascular, pulmonary, hormonal, and thrombotic systems challenge the complex PAH physiology. Due to the high risks, patients with PAH are currently counseled against pregnancy based on international consensus guidelines, but there are promising signs of improving outcomes, particularly for patients with mild disease. For patients who become pregnant, multidisciplinary care at a PAH specialist center is needed for peripartum monitoring, medication management, delivery, postpartum care, and complication management. Patients with PAH also require disease-specific counseling on contraception and breastfeeding. In this review, we detail the considerations for reproductive planning, pregnancy, and delivery for the multidisciplinary care of a patient with PAH.

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Use of Extracorporeal Membrane Oxygenation in Postpartum Management of a Patient with Pulmonary Arterial Hypertension

Cited by 4 publications

References 22 publications

Management of pregnant patients with pulmonary arterial hypertension

Management of pregnant patients with pulmonary arterial hypertension

Critical care management of pulmonary arterial hypertension in pregnancy: the pre-, peri- and post-partum stages

Pregnancy Considerations in the Multidisciplinary Care of Patients with Pulmonary Arterial Hypertension

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