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Updated: Jul 3, 2026
Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting
Published on: January 17, 2025
Contemporary approaches to extracorporeal membrane oxygenation usage in extended peripartum period over a decade - a
Samhati Mondal1, Khang Lee2, Lena Kheirbek3
1Department of Anesthesiology, University of Maryland School of Medicine, 22 S Greene Street, Baltimore, MD, 21201, USA. smondal@som.umaryland.edu.
Background:
Extracorporeal membrane oxygenation (ECMO) has become a valuable tool in critical care medicine when conventional treatment to severe cardiopulmonary failure fails. ECMO use in adults has significantly increased over the past several years to approximately 60 per million adults because of its potential survival benefits. This drastic increase in ECMO use comes from its technological evolution over the last decade. However, ECMO utilization in obstetric patients remains limited, although the incidence of life-threatening cardiopulmonary conditions potentially benefiting from ECMO continues to rise in these patients. The objective of this systematic review was to evaluate the evolution of ECMO and its use in the extended peripartum period.
Method:
PRISMA 2020 guidelines were followed. We constructed searches in PubMed, Embase, and the Cochrane Central Register of Controlled Trials (Wiley). Results were limited to articles published since 2010 with adult subjects till 2020.
Selection Criteria:
Inclusion criteria Literature published in English since 2010 regarding adult peripartum patients requiring ECMO extending up to 3 months post-delivery. Exclusion criteria Animal studies, National Inpatient Sample (NIS) data, reviews, editorials, and conference abstracts. Cases involving EXIT-to-ECMO or support initiated beyond three months postpartum were also excluded. Data was collected and reviewed using Covidence portal. Initially, 2169 studies were screened for title and abstract review. Afterwards, 304 studies were selected for retrieval and full text review. Finally,136 articles were included in the study after full text review.
Results:
Studies were separated based on their nature into two broad groups - case reports (110) and cohort studies & case series (26). The most common indication to initiate ECMO was cardiomyopathy (heart failure), and most mothers requiring ECMO were in the antenatal period. Mean duration on ECMO was 8, 9 and 11 days (case series, case reports and cohort studies, respectively). Maternal survival was noted to be as high as 89% in case reports, 87% in case series, and 78% in cohort studies. Fetal survival rate was also generally high. Nevertheless, it is important to point out that a significant number of the included studies did not report fetal outcomes and, hence, the fetal survival rate could not be confidently inferred.
Conclusions:
Timely initiation of ECMO in the peripartum period is associated with favorable maternal and fetal outcomes. Given the rarity of ECMO utilization in obstetrics, case reports were highly represented in the study. Accordingly, regression findings should be interpreted cautiously and considered hypothesis-generating rather than confirmatory.
