Extracorporeal Life Support for Cardiorespiratory Collapse After Delayed Diagnosis and Related Complications of Postpartum Preeclampsia

Published:October 28, 2022DOI:
      AS CLINICIANS PUSH FORWARD into the future of obstetrical care and mechanical circulatory support, they will increasingly find these 2 seemingly separate environments intersecting as complexity grows within the obstetric population. Care for these challenging patients brings to light the present systemic biases that are integrated into the very medical infrastructure from which care is provided. The case presented here highlights these facts, and demonstrates a need for clinical and systemic growth and improvement regarding the recognition of peripartum complications and the need to mitigate the morbidity and mortality associated with potential bias. In this case, the use of mechanical circulatory support was only necessary because of repeated failures to intervene prior to the patient's decompensation. Though the authors’ institution, and many others, are capable of such heroics, the bigger question lies in why this happened at all and how can this need be prevented, rather than celebrate its success.

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        • Petersen EE
        • Davis NL
        • Goodman D
        • et al.
        Vital signs: Pregnancy-related deaths, United States, 2011-2015, and strategies for prevention, 13 states, 2013-2017.
        MMWR Morb Mortal Wkly Rep. 2019; 68: 423-429
        • Kuklina EV
        • Ayala C
        • Callaghan WM.
        Hypertensive disorders and severe obstetric morbidity in the United States.
        Obstet Gynecol. 2009; 113: 1299-1306
        • Ives CW
        • Sinkey R
        • Rajapreyar I
        • et al.
        Preeclampsia-pathophysiology and clinical presentations: JACC state-of-the-art review.
        J Am Coll Cardiol. 2020; 76: 1690-1702
        • Rana S
        • Lemoine E
        • Granger JP
        • et al.
        Preeclampsia: Pathophysiology, challenges, and perspectives.
        Circ Res. 2019; 124: 1094-1112
        • Wagner SJ
        • Acquah LA
        • Lindell EP
        • et al.
        Posterior reversible encephalopathy syndrome and eclampsia: Pressing the case for more aggressive blood pressure control.
        Mayo Clin Proc. 2011; 86: 851-856
        • Hauspurg A
        • Jeyabalan A.
        Postpartum preeclampsia or eclampsia: Defining its place and management among the hypertensive disorders of pregnancy.
        Am J Obstet Gynecol. 2022; 226: S1211-S1S21
        • McGinnis R
        • Steinthorsdottir V
        • Williams NO
        • et al.
        Variants in the fetal genome near FLT1 are associated with risk of preeclampsia.
        Nat Genet. 2017; 49: 1255-1260
        • Gray KJ
        • Kovacheva VP
        • Mirzakhani H
        • et al.
        Gene-centric analysis of preeclampsia identifies maternal association at PLEKHG1.
        Hypertension. 2018; 72: 408-416
        • Bartsch E
        • Medcalf KE
        • Park AL
        • et al.
        Clinical risk factors for pre-eclampsia determined in early pregnancy: Systematic review and meta-analysis of large cohort studies.
        BMJ. 2016; 353: i1753
        • Bello N
        • Rendon ISH
        • Arany Z.
        The relationship between pre-eclampsia and peripartum cardiomyopathy: A systematic review and meta-analysis.
        J Am Coll Cardiol. 2013; 62: 1715-1723
        • Pfeffer TJ
        • Hilfiker-Kleiner D.
        Pregnancy and heart disease: Pregnancy-associated hypertension and peripartum cardiomyopathy.
        Curr Probl Cardiol. 2018; 43: 364-388
        • Douglass EJ
        • Blauwet LA.
        Peripartum cardiomyopathy.
        Cardiol Clin. 2021; 39: 119-142
        • Kerpen K
        • Koutrolou-Sotiropoulou P
        • Zhu C
        • et al.
        Disparities in death rates in women with peripartum cardiomyopathy between advanced and developing countries: A systematic review and meta-analysis.
        Arch Cardiovasc Dis. 2019; 112: 187-198
        • Cooper LT
        • Mather PJ
        • Alexis JD
        • et al.
        Myocardial recovery in peripartum cardiomyopathy: Prospective comparison with recent onset cardiomyopathy in men and nonperipartum women.
        J Card Fail. 2012; 18: 28-33
        • Felker GM
        • Jaeger CJ
        • Klodas E
        • et al.
        Myocarditis and long-term survival in peripartum cardiomyopathy.
        Am Heart J. 2000; 140: 785-791
        • McNamara DM
        • Elkayam U
        • Alharethi R
        • et al.
        Clinical outcomes for peripartum cardiomyopathy in North America: Results of the IPAC study (Investigations of Pregnancy-Associated Cardiomyopathy).
        J Am Coll Cardiol. 2015; 66: 905-914
        • Sugahara M
        • Kagiyama N
        • Hasselberg NE
        • et al.
        Global left ventricular strain at presentation is associated with subsequent recovery in patients with peripartum cardiomyopathy.
        J Am Soc Echocardiogr. 2019; 32: 1565-1573
        • Blauwet LA
        • Delgado-Montero A
        • Ryo K
        • et al.
        Right ventricular function in peripartum cardiomyopathy at presentation is associated with subsequent left ventricular recovery and clinical outcomes.
        Circ Heart Fail. 2016; 9e002756
        • Kolte D
        • Khera S
        • Aronow WS
        • et al.
        Temporal trends in incidence and outcomes of peripartum cardiomyopathy in the United States: A nationwide population-based study.
        J Am Heart Assoc. 2014; 3e001056
        • Loyaga-Rendon RY
        • Pamboukian SV
        • Tallaj JA
        • et al.
        Outcomes of patients with peripartum cardiomyopathy who received mechanical circulatory support. Data from the Interagency Registry for Mechanically Assisted Circulatory Support.
        Circ Heart Fail. 2014; 7: 300-309
        • Sebastian NA
        • Spence AR
        • Bouhadoun S
        • Abenhaim HA.
        Extracorporeal membrane oxygenation in pregnant and postpartum patients: a systematic review.
        J Matern Fetal Neonatal Med. 2022; 35: 4463-4473
        • Naoum EE
        • Chalupka A
        • Haft J
        • et al.
        Extracorporeal life support in pregnancy: A systematic review.
        J Am Heart Assoc. 2020; 9e016072
        • Howell EA.
        Reducing disparities in severe maternal morbidity and mortality.
        Clin Obstet Gynecol. 2018; 61: 387-399
        • Johnson JD
        • Louis JM.
        Does race or ethnicity play a role in the origin, pathophysiology, and outcomes of preeclampsia? An expert review of the literature.
        Am J Obstet Gynecol. 2022; 226: S876-S885
        • Liese KL
        • Mogos M
        • Abboud S
        • et al.
        Racial and ethnic disparities in severe maternal morbidity in the United States.
        J Racial Ethn Health Disparities. 2019; 6: 790-798
        • MacDorman MF
        • Thoma M
        • Declcerq E
        • et al.
        Racial and ethnic disparities in maternal mortality in the United States using enhanced vital records, 2016-2017.
        Am J Public Health. 2021; 111: 1673-1681
        • Vallabhajosyula S
        • Ya'Qoub L
        • Singh M
        • et al.
        Sex disparities in the management and outcomes of cardiogenic shock complicating acute myocardial infarction in the young.
        Circ Heart Fail. 2020; 13e007154
        • Thangam M
        • Luke AA
        • Johnson DY
        • et al.
        Sociodemographic differences in utilization and outcomes for temporary cardiovascular mechanical support in the setting of cardiogenic shock.
        Am Heart J. 2021; 236: 87-96
        • Vallabhajosyula S
        • Dunlay SM
        • Barsness GW
        • et al.
        Sex disparities in the use and outcomes of temporary mechanical circulatory support for acute myocardial infarction-cardiogenic shock.
        CJC Open. 2020; 2: 462-472