Standby Extracorporeal Membrane Oxygenation Use in Obstetric Patients: A Systematized Review

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) is a potentially life-saving intervention often used in critically ill patients with severe respiratory or cardiac failure unresponsive to conventional treatments. As the prevalence of high-risk obstetric patients has increased, indications for ECMO have been identified in this population, as evidenced by an increased number of cases reported in the last decade. Although the indications for ECMO are not different for pregnant patients and nonpregnant patients, given the high-risk nature of certain peripartum conditions, there has been increased interest in the use of standby ECMO or precannulation ECMO, to enable rapid deployment of venoarterial ECMO should it be necessary. The present systematized review identified 14,717 obstetric patients, of whom 1041 received ECMO and 11 were considered for or received standby ECMO. The indications, risks, and considerations related to stand-by ECMO use are described. As no consensus guidelines exist for the peripartum use of stand-by ECMO, more research is needed to establish future practice guidelines for determining suitable candidates and improving maternal outcomes.