ABSTRACT
Objectives: To describe the IPT collaborative approach for peripartum women with COVID-19 on ECMO and report the intervention outcomes. Method(s): A retrospective electronic health record review was performed from January 2020 through January 2022. All peripartum women on ECMO with COVID19 admitted to the cardiothoracic intensive care unit (CTICU) were included. The IPT came together to coordinate peripartum care and delivery. An algorithm was created to outline the roles and workflow in the care of these patients. The outcomes evaluated included delivery method, timing, and location, maternal survival at discharge, maternal ICU length of stay (LOS), and neonatal survival Results: Thirteen Peropartum women were placed on ECMO (5 antepartum and 8 postpartum, ages 27-42). None had been vaccinated against COVID-19. All received femoral vessel cannulation (11 venovenous and 2 venoarterial). Four patients underwent Caesareansection delivery while on ECMO. Maternal survival to hospital discharge was 84.6%. All neonates survived with COVID-19 negative status. Conclusion(s): The collaborative IPT approach with a structured algorithm facilitated survival outcomes. This report adds to the limited literature on peripartum. ECMO and provides insights to consider in planning for the care of these patients.
ABSTRACT
Background: There is limited evidence on the benefits of PPT for ECMO patients. Purpose(s): To describe the PPT process and assess its impact on COVID-19 patients supported with ECMO. Method(s): A retrospective electronic health record review was performed to compare the outcomes of patients treated with PPT with a matched cohort of non-proned patients. From January 2020 to January 2022, all COVID-19 ECMO patients admitted to the cardiothoracic intensive care unit (CTICU) of a large academic medical center were included. ECMO PPT protocol was created by the unit inter-professional team (IPT), to standardize the approach and maintain a safe practice. The unit education committee provided the training for PPT. The outcomes assessed were complications due to PPT, ECMO run time, survival at decannulation, and the highest level of mobility while supported on ECMO. Result(s): Seventy-nine COVID-19 patients were supported on veno-venous ECMO in the CTICU. Of these patients, 41.7% received at least one 16-hour PPT session per day. There were no severe complications attributed to PPT. There were no differences in survival rate at decannulation between proned and non-proned patients. Further analyses compared proned patients to non-proned patients matched by age, gender, body mass index and comorbidities to evaluate the outcomes. Conclusion(s): Our IPT approach with a standardized protocol guided the successful PPT of these patients with no significant major adverse events. This single-center report shows no difference in survival at decannulation between the two groups. Further subgroup analysis is expected to guide future case selection.