Extracorporeal Life Support in Pregnancy: A Systematic Review

Abstract

Background The use of extracorporeal life support ( ECLS ) has expanded to include unique populations such as peripartum women. This systematic review aims to (1) quantify the number of cases and indications for ECLS in women during the peripartum period reported in the literature and (2) report maternal and fetal complications and outcomes associated with peripartum ECLS . Methods and Results This review was registered in PROSPERO ( CRD 42018108142). MEDLINE , Embase, and CINAHL were searched for case reports, case series, and studies reporting cases of ECLS during the peripartum period that reported one or more of the following outcomes: maternal survival, maternal complications, fetal survival, and/or fetal complications. Qualitative assessment of 221 publications evaluated the number of cases, clinical details, and maternal and fetal outcomes of ECLS during the peripartum period. There were 358 women included and 68 reported fetal outcomes in cases where the mother was pregnant at the time of cannulation. The aggregate maternal survival at 30 days was 270 (75.4%) and at 1 year was 266 (74.3%); fetal survival was 44 (64.7%). The most common indications for ECLS overall in pregnancy included acute respiratory distress syndrome 177 (49.4%), cardiac failure 67 (18.7%), and cardiac arrest 57 (15.9%). The most common maternal complications included mild to moderate bleeding 66 (18.4%), severe bleeding requiring surgical intervention 48 (13.4%), and intracranial neurologic morbidity 19 (5.3%). The most commonly reported fetal complications included preterm delivery 33 (48.5%) and neonatal intensive care unit admission 19 (27.9%). Conclusions Reported rates of survival in ECLS in pregnant and postpartum women are high and major complications relatively low.

Successful Treatment of Pregnant and Postpartum Women With Severe COVID-19 Associated Acute Respiratory Distress Syndrome With Extracorporeal Membrane Oxygenation

“… 5 The overall most common complication on ECMO for peripartum patients remains bleeding. 9 Two of our patients experienced minor bleeding but no major complications during ECMO, alike to the two cases reported. 5 , 6 The most common complication reported in ECMO for COVID-19 ARDS was circuit change (15%), which mirrors our complication rate for circuit/oxygenator clotting (22%).…”

Successful Use of Extracorporeal Membrane Oxygenation Postpartum as Rescue Therapy in a Woman With COVID-19

“…12 , 13 , 14 The most common complication remains bleeding that contributes to significant maternal morbidity and mortality. 11 , 14 The indication and type of ECMO (venovenous or venoarterial) seem to be unrelated to survival. 12 , 14 …”

“… 11 , 14 The indication and type of ECMO (venovenous or venoarterial) seem to be unrelated to survival. 12 , 14 …”

Maternal-Neonatal Dyad Outcomes of Maternal COVID-19 Requiring Extracorporeal Membrane Support: A Case Series

“…For case B, delivery occurred due to preterm labor, a known risk both with COVID-19 infection and in patients on ECMO. 5 9 Current recommendations suggest that timing and mode of delivery in COVID-19-positive pregnant women be based on routine obstetrical indications, and delivery should not be used as a treatment to improve maternal respiratory symptoms, except in cases of maternal cardiac arrest; however, in the setting of ECMO, while delivery is not recommended to improve maternal respiratory status, the risks and benefits of preterm delivery versus remaining on ECMO for a prolonged period of time must be considered. 11 Pharmacologic treatment options such as remdesivir, interleukin (IL)-6 modulators, and convalescent plasma has not been extensively studied in pregnant women but use is appropriate in critically ill women as compassionate use.…”

“…The study noted an overall 30-day maternal survival rate of 75%, with a 3 to 18% rate of major maternal complications, and 49% rate of preterm delivery. 9 We report the maternal and fetal outcomes of two critically ill pregnant women who required ECMO support for COVID-19.…”