Poster Session 2
Category: Medical/Surgical/Diseases/Complications
Poster Session 2
Ryan W. Wong, MD (he/him/his)
Resident Physician
Center for Women’s Reproductive Health Department of Obstetrics and Gynecology University of Alabama at Birmingham
Birmingham, Alabama, United States
Rachel G. Sinkey, MD (she/her/hers)
Associate Professor of Obstetrics & Gynecology
Center for Women’s Reproductive Health Department of Obstetrics and Gynecology University of Alabama at Birmingham
Birmingham, Alabama, United States
Amir A. Shamshirsaz, MD
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine
Houston, Texas, United States
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Mark A. Turrentine, MD
Professor
Department of Obstetrics and Gynecology Baylor College of Medicine
Houston, Texas, United States
Alison G. G. Cahill, MD, MSCI
Assoc. Dean, Translational Research; Prof, Women’s Health; Dir, Health Transformation Research Inst.
Department of Women’s Health, Dell Medical School at the University of Texas at Austin
Department of Women’s Health, Dell Medical School at the University of Texas at Austin, Texas, United States
Joe Eid, MD
Department of Obstetrics and Gynecology The Ohio State University College of Medicine
Columbus, Ohio, United States
Caroline E. Rouse, MD (she/her/hers)
Assistant Professor of Clinical Obstetrics and Gynecology
Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine Indiana University School of Medicine
Indianapolis, Indiana, United States
Sohum Shah, MD (he/him/his)
Fellow
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine at University of California, Los Angeles (UCLA)
Los Angeles, California, United States
Nandini Raghuraman, MD, MSCI
Associate Professor
Washington University School of Medicine
St. Louis, Missouri, United States
Mariam Naqvi, MD (she/her/hers)
Associate Professor, Maternal Fetal Medicine
Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center
Los Angeles, California, United States
Yasser Y. El-Sayed, MD
Director, Maternal-Fetal Medicine
Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine and Obstetrics Stanford University
Palo Alto, California, United States
Martina Badell, MD (she/her/hers)
Professor
Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine Emory University School of Medicine
Atlanta, Georgia, United States
CeCe Cheng, MD (she/her/hers)
Assistant Professor
Department of Obstetrics and Gynecology Methodist Hospital
San Antonio, Texas, United States
Robert M. Rossi, MD
Assistant Professor
Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine University of Cincinnati College of Medicine
Cincinnati, Ohio, United States
Emily H. Adhikari, MD (she/her/hers)
Associate Professor
University of Texas Southwestern Medical Center
Dallas, Texas, United States
Jennifer L. Thompson, MD
Vanderbilt University Medical Center
Nashville, Tennessee, United States
Erika O’Neil, MD
Department of Pediatrics Brooke Army Medical Center
San Antonio, Texas, United States
Emily Naoum, MD
Department of Anesthesia Critical Care and Pain Medicine Massachusetts General Hospital
Boston, Massachusetts, United States
.jpg "Patrick S. Ramsey, MD, MSPH (he/him/his) photo")
Patrick S. Ramsey, MD, MSPH (he/him/his)
Professor, Vice Chair Inpatient Obstetrics
Department of Obstetrics and Gynecology University of Texas Health Science Center in San Antonio
San Antonio, Texas, United States
John J. Byrne, MD, MPH
Assistant Professor
University of Texas Health Science Center in San Antonio
San Antonio, Texas, United States
Increased driving distance to maternity hospitals has been associated with higher risk of adverse maternal/perinatal outcomes; however, the association between distance and outcomes among pregnant patients requiring ECMO is unknown. We evaluated the association between distance from patients’ homes to the tertiary center from which they received ECMO to investigate whether distance was associated with adverse outcomes.
Study Design:
Secondary analysis of a national 25-center COVID-19 ECMO consortium, 3/1/20-10/1/22. All cohort subjects, N=100, were included. Exposure was the distance between patients’ homes & their tertiary centers, based on zip codes. The primary outcome was a serious maternal morbidity composite that included: death, venous thromboembolism (VTE), ischemic stroke or intracranial hemorrhage, acute kidney injury, gastrointestinal bleeding, liver failure, non-cardiac/non-intracranial ischemic injuries, and any one of several possible cardiac complications. Secondarily, we examined components of the composite and selected obstetric and neonatal outcomes. Logistic regression modeled the association between distance and the odds of selected outcomes.
Results:
Patient characteristics are shown in Table 1. ECMO was initiated during pregnancy, within 24 hours postpartum, and 24 hours – 6 weeks postpartum among 47%, 21% and 32% of patients. Mean ± SD (median) distance from home to the ECMO center was 65 ± 113 (31) miles. The primary composite outcome occurred in 76%, and there was a null association (p=0.70) between distance and composite morbidity. Maternal death (16%) was also not associated with distance (p=0.22). The most common component of the composite was VTE, 39%. Associations of distance with individual components of the composite are in Table 2.
Conclusion:
In a multicenter study of severe COVID-19 cases in pregnancy/postpartum, distance from a patient’s home to the ECMO center was not associated with increased odds of selected adverse outcomes. Available resources appeared to have overcome geographic obstacles in patients who received ECMO for severe COVID-19.