Extra-Corporeal Membrane Oxygenation in Pregnancy.

Area of Science:

• Critical Care Medicine
• Maternal-Fetal Medicine
• Cardiopulmonary Support

Background:

• Extracorporeal membrane oxygenation (ECMO) provides advanced cardiac or pulmonary support for refractory organ failure.
• Limited Level I evidence exists for ECMO's efficacy in pregnant populations, necessitating careful case selection and specialized centers.
• Pregnancy presents unique physiological challenges that may influence the indications and outcomes of ECMO therapy.

Purpose of the Study:

• To review the properties and indications of venous-venous (VV-ECMO) and venous-arterial (VA-ECMO) in pregnant women.
• To consolidate current evidence on ECMO use in obstetric patients, including maternal and fetal outcomes.
• To highlight ECMO as a therapeutic option for severe conditions unresponsive to standard medical care during pregnancy.

Main Methods:

• Systematic literature search of major scientific databases from 2009 to December 2023.
• Inclusion of ClinicalTrials.gov for ongoing and recently conducted studies.
• Keyword-based article selection focusing on ECMO, pregnancy, H1N1, COVID-19, ARDS, and cardiac arrest, with final review of 43 relevant papers.

Main Results:

• ECMO encompasses VV-ECMO for severe hypoxia and VA-ECMO for circulatory support, aiding organ rest and preventing multi-organ failure.
• Key indications in pregnant women include cardiogenic shock, ARDS, pulmonary embolism, eclampsia, fetal distress, hypoxic-ischemic encephalopathy, and TTTS.
• Studies indicate ECMO is a successful strategy for critical conditions unresponsive to medical treatment, with low maternal and fetal complication risks in selected patients.

Conclusions:

• ECMO (both VV and VA types) is a viable and potentially life-saving intervention for critically ill pregnant women.
• Careful patient selection and management in specialized centers are crucial for optimizing outcomes.
• Further research is warranted to strengthen the evidence base for ECMO in pregnancy.