Extracorporeal Membrane Oxygenation for Pregnant and Postpartum Patients

Michael J. Wong, MD; Shobana Bharadwaj, MBBS; Jessica L. Galey, MD; Allison S. Lankford, MD; Samuel Galvagno, DO, PhD; Bhavani Shankar Kodali, MD

Disclosures

Anesth Analg. 2022;135(2):277-289. 

In This Article

Abstract and Introduction

Abstract

Extracorporeal membrane oxygenation (ECMO) has seen increasing use for critically ill pregnant and postpartum patients over the past decade. Growing experience continues to demonstrate the feasibility of ECMO in obstetric patients and attest to its favorable outcomes. However, the interaction of pregnancy physiology with ECMO life support requires careful planning and adaptation for success. Additionally, the maintenance of fetal oxygenation and perfusion is essential for safely continuing pregnancy during ECMO support. This review summarizes the considerations for use of ECMO in obstetric patients and how to address these concerns.

Introduction

See Article, page 264Extracorporeal membrane oxygenation (ECMO) was historically seldom used for pregnant and postpartum patients but there is now growing interest, as reflected by a burgeoning body of case reports in the past decade.[1] To date, few centers have substantial experience in ECMO support for this population due, in part, to the infrequent nature of critical illness among pregnant and peripartum women.[2,3] Altered maternal physiology, maintenance of fetal well-being, and obstetric emergencies are all significant challenges for critical care clinicians, and current ECMO guidelines do not address considerations to optimize maternal and fetal outcomes.[4,5] In this review, we present the relevant considerations for ECMO life support in pregnant and postpartum patients, as well as the practical adaptations that must be made to accommodate the physiologic changes of pregnancy.

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