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Background: The leading causes of maternal mortality include respiratory failure, cardiovascular events, infections, and hemorrhages. The use of extracorporeal membrane oxygenation (ECMO) as rescue therapy in the peripartum period for cardiopulmonary failure is expanding in critical care medicine. Methods: This retrospective observational study was conducted on a nationwide cohort in Israel. During the 3‐year period, between September 1, 2019, and August 31, 2022, all women in the peripartum period who had been supported by ECMO for respiratory or circulatory failure at 10 large Israeli hospitals were identified. Indications for ECMO, maternal and neonatal outcomes, details of ECMO support, and complications were collected. Results: During the 3‐year study period, in Israel, there were 540 234 live births, and 28 obstetric patients were supported by ECMO, with an incidence of 5.2 cases per 100 000 or 1 case per 19 000 births (when excluding patients with COVID‐19, the incidence will be 2.5 cases per 100 000 births). Of these, 25 were during the postpartum period, of which 16 (64%) were connected in the PPD1, and 3 were during pregnancy. Eighteen patients (64.3%) were supported by V‐V ECMO, 9 (32.1%) by V‐A ECMO, and one (3.6%) by a VV‐A configuration. Hypoxic respiratory failure (ARDS) was the most common indication for ECMO, observed in 21 patients (75%). COVID‐19 was the cause of ARDS in 15 (53.7%) patients. The indications for the V‐A configuration were cardiomyopathy (3 patients), amniotic fluid embolism (2 patients), sepsis, and pulmonary hypertension. The maternal and fetal survival rates were 89.3% (n = 25) and 100% (n = 28). The average ECMO duration was 17.6 ± 18.6 days and the ICU stay was 29.8 ± 23.8 days. Major bleeding complications requiring surgical intervention were observed in one patient. Conclusions: The incidence of using ECMO in the peripartum period is low. The maternal and neonatal survival rates in patients treated with ECMO are high. These results show that ECMO remains an important treatment option for obstetric patients with respiratory and/or cardiopulmonary failure. [ABSTRACT FROM AUTHOR]

Background: Preanesthesia evaluation is a basic practice preceding any surgical procedure, aimed at tailoring individualized anesthetic plans for patients, improving safety, and providing patients with educational knowledge and tools in preparation for the surgery day. In the last 2 decades, eHealth and mobile health (mHealth) settings have gradually replaced part of the face-to-face encounters as the platform for preanesthesia communication between doctor and patient, yielding a range of benefits as demonstrated in recent publications. Nevertheless, there is a lack of studies examining the effectiveness of surgical mHealth apps focusing on the pediatric preanesthetic setting and addressing their usability among families. Objective: This study describes a dynamic approach for the development process of GistMD’s preanesthesia mHealth system, a mobile-based educational and management system designed for the pediatric setting. Methods: The study was conducted in 4 departments at a 1500-bed quaternary, academic medical center in Tel Aviv, Israel. During the study period, the link to the preanesthesia system was sent via SMS text messages to families whose children were about to undergo surgery. The system included preanesthesia questionnaires, educational videos, downloadable instructions, and consent forms. Continuous collection and examination of usability data were conducted during the implementation term including responsiveness, effectiveness, and satisfaction indicators. The information collected in each stage was used to draw conclusions regarding potential usability gaps of the system and to plan product adjustments for the following period. Results: During 141 days of implementation, the link to the GistMD preanesthesia management system was sent to 769 families, and product-fit actions were implemented during this term: (1) changing text message scheduling for addressing learnability and accessibility, resulting in a significant increase of 27% (χ² 1=12.65, P<.001) in view rates and 27.4% (χ² 1=30.01, P<.001) in satisfaction rates; (2) reducing the number of screens to increase efficiency and operability, leading to a significant decrease of 8.6% in cases where users did not perform any activity on the system after logging in (χ² 1=6.18, P=.02); (3) conducting a patient-focused campaign in 2 departments aimed at addressing memorability, leading to significant increases in 8 of the 12 usability indicators. Conclusions: Our results indicate that mHealth product-fit decisions originating from theory-based approaches and ongoing usability data analysis allow tailoring of the most appropriate responses for usability gaps, as reflected in increased use rates and satisfaction. In the case of the preanesthesia management system in the pediatric setting, increased usability conveyed important benefits for patients and families. This work suggests a framework and study methods that may also be applicable in other mHealth settings and domains. [ABSTRACT FROM AUTHOR]