專題討論11:母嬰醫學之新進展
      New development of maternal-fetal medicine

程 序 表

S11-4
產科重症病人之葉克膜使用
林明緯
臺大醫院婦產科

  Extracorporeal membrane oxygenation (ECMO) is widely used as a temporarily support for severe acute cardiopulmonary patient leading to organ recovery. Bleeding is a common complication with patient on ECMO due to heparinisation to prevent blood clot formation in the ECMO circuit. Fear of bleeding impedes the use of ECMO in severe postpartum hemorrhage cases. Here, we share our experience on ECMO application on severe postpartum hemorrhage cases at NTUH over a five-year period. Five patients who suffered from post-partum hemorrhage complicated with hemorrhagic shock and cardiopulmonary suppression were supported by ECMO. The mean age was 36.8 ± 3.9 years; the mean gestational age was 37.8 ± 2.2 weeks; the initial mean maternal hemoglobin level was 5.0 ± 2.4 mg/dL; and the mean estimated blood loss was 3260 ± 1545 mL before treatment. All patients were treated with venoarterial ECMO and one was treated with both venoarterial and venovenous ECMO. The mean ECMO usage duration was 32.6 ± 18.8 h (range 10–54). Four (80%) patients survived until discharge without experiencing neurological sequela. ECMO should not be a contraindication for patients who need temporarily cardiopulmonary support suffered by post-partum hemorrhage and such patients should be weaned as soon as possible to ensure the early recovery of cardiac function.