Extracorporeal membrane oxygenation in pregnancy and the post-partum period: a systematic review and meta-analysis

There is an increase in the application data of Extracorporeal Membrane Oxygenation (ECMO) in perinatal women, particularly since the outbreak of coronavirus disease 2019. Therefore, we reviewed publications on the use of ECMO in pregnant and postpartum women and analyzed the maternal and fetal outcomes, updated the progress of ECMO in perinatal women.

We conducted a systematic literature search across PubMed, EMBASE, Cochrane Library, and the International Clinical Trials Registry (ICTRP), yielding 30 eligible clinical studies that investigated the application of ECMO during pregnancy. A comprehensive data extraction process was implemented to retrieve information from these selected studies. A single rate analysis on material survival, material harmonic compilations, and fetus survival were performed by R software.

Of the 1460 women included, our primary outcome was maternal survival: 74.4% (95% confidence interval [CI]: 67.8%-81.1%). Among them, the survival rate of VV ECMO patients was 83.6% (95% confidence interval [CI]: 76.4%-90.8%); the survival rate of VA ECMO patients was 62.8% (95% confidence interval [CI]: 48.7%-76.8%). The secondary outcomes were maternal hemorrhagic complications: 34.8% (95% [CI]: 24.1%-45.5%), and fetal survival: 73.2% (95% [CI]: 62.0%-84.4%).

Our analysis revealed that the outcomes of ECMO (both type) use in pregnant patients may be comparable or superior to those observed in non-pregnant cohorts. Moreover, patients treated with VV ECMO exhibited a significantly higher survival rate compared to those on VA ECMO.

The protocol for this systematic review was registered on INPLASY (2022110036) in 11 November 2022.