Heart and lung machine boosts survival for pregnant women with PAH
Case series reviewed the outcomes of 5 patients
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A life-support machine that temporarily replaces the heart and lungs — known as extracorporeal membrane oxygenation (ECMO) — boosts survival among pregnant women who develop severe pulmonary arterial hypertension (PAH).
That’s according to a case series and literature review that found ECMO use in pregnancy-related PAH has improved survival rates compared with the pre-ECMO era.
“This study reinforces [ECMO’s] role as an effective rescue therapy for pregnant/postpartum patients with severe PAH,” researchers wrote.
Case and review details were reported in the study, “Extracorporeal membrane oxygenation for pulmonary arterial hypertension complicating pregnancy: case series and literature review,” published in BMC Pregnancy and Childbirth.
PAH during pregnancy a serious complication, with high risk of death
PAH during pregnancy is a serious complication, with a high risk of death, especially around the time of delivery or shortly after. Pregnancy can drive up blood pressure in the pulmonary arteries, the lung’s blood vessels, and overwhelm the right side of the heart, putting both mother and baby at risk.
In severe cases, doctors may use ECMO — a machine that temporarily oxygenates a patient’s blood when the heart and lungs are no longer functioning properly. Still, using ECMO in pregnancy is complex and challenging, and guidance is limited.
This study described the outcomes of five pregnant women with PAH treated with ECMO “to provide insights into the management and optimization of ECMO support for pregnant patients with PAH,” the researchers wrote.
In the first case, a 24-year-old woman had a history of heart disease after surgery to correct a hole in the heart as a child. She developed severe PAH late in pregnancy. At 32 weeks, she required an emergency cesarean section, and her baby boy was born early.
The mother’s condition worsened. She experienced a cardiac arrest and was placed on ECMO for life support. Despite intensive treatment, she developed serious complications and died, while her newborn survived.
The second case involved a 19-year-old woman who was 31 weeks pregnant and was admitted to the hospital after several weeks of worsening shortness of breath. She was diagnosed with a congenital heart condition, patent ductus arteriosus, along with severe PAH. Because she was unstable, she underwent an emergency cesarean section. Her baby boy was delivered early and survived.
After delivery, the mother’s heart and circulation remained unstable, requiring intensive care and ECMO. She needed ECMO twice due to episodes of heart and breathing failure, and she developed serious infections while in the hospital. After several weeks of treatment, she improved and was discharged with PAH medications. Both the mother and baby survived.
Congenital heart disease most common cause of PAH among 36 cases
In the third case, a 35-year-old woman who was 35 weeks pregnant was admitted with severe PAH, causing shortness of breath. After delivery, she developed lung failure, and her oxygen levels remained dangerously low despite medications to treat her lung condition.
She was placed on ECMO for three days, developing minor complications, including a temporary blood-clotting abnormality and influenza, but her condition steadily improved. She was able to stop ECMO, recovered well, and was discharged on PAH medications. The mother and her baby survived.
The fourth case described a 24-year-old woman who was 32 weeks pregnant. She was brought to the hospital after experiencing a cardiac arrest caused by a hole in the heart and severe PAH. She was immediately started on ECMO and underwent an emergency cesarean section at the same time. Her baby boy was born early but survived.
The mother remained on ECMO support after delivery, and received anticoagulants (blood-thinners). She experienced several serious complications, including low levels of platelets (the cell fragments that help blood clot), a blood clot in a thigh vein, and kidney failure that required dialysis. With care, she improved, was able to stop ECMO, and was discharged on PAH medication. Both the mother and baby survived.
The 58.1% maternal survival rate in this cohort demonstrates its potential advantage as a rescue therapy, compared with the [30%-50%] mortality rate in the pre-ECMO era.
Lastly, a 28-year-old woman who was 26 weeks pregnant was admitted because her baby was not growing well, and she had severe PAH caused by a congenital heart defect that had progressed. Doctors started ECMO before surgery to support her circulation and oxygen levels. She was briefly taken off ECMO, but needed it again when her blood oxygen levels dropped. During her stay, she developed a serious bloodstream infection, which was treated.
After several weeks of intensive care, she improved enough to come off ECMO and was discharged in stable condition on PAH medication. Both the mother and her newborn survived.
The team also reviewed the published literature on the use of ECMO in pregnancy-related PAH, which reported on 36 cases. The most common cause of PAH was congenital heart disease, and nearly all (96.4%) women underwent a cesarean section. ECMO was the most common treatment (70.9%), primarily due to cardiac arrest, blood flow problems, and preemptive support. More than half (58.1%) of the mothers survived.
“The 58.1% maternal survival rate in this cohort demonstrates its potential advantage as a rescue therapy, compared with the [30%-50%] mortality rate in the pre-ECMO era,” the team noted. “Future work should focus on standardizing management protocols, reducing complications, and enhancing long-term quality of life for survivors.”
