Extracorporeal Membrane Oxygenation in Pregnant and Postpartum Women: A Systematic Review and Meta-Regression Analysis

John J. Y. Zhang*, Jamie Ann-Hui Ong, Nicholas L. Syn, Roberto Lorusso, Chuen Seng Tan, Graeme MacLaren, Kollengode Ramanathan

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

22 Citations (Web of Science)

Abstract

Background: Although extracorporeal membrane oxygenation (ECMO) is frequently utilized as a salvage therapy for patients with cardiopulmonary failure, outcomes of its use in peripartum patients have not been clearly established. We aimed to review peer-reviewed publications on the use of ECMO in pregnant and postpartum patients, with analyses of maternal and fetal outcomes. Methods: Data were retrieved from MEDLINE, EMBASE, and Scopus databases from 1972 up to November 2017 for publications on ECMO in peripartum patients. Search terms included "ECMO," "ECLS,", "pregnancy," "postpartum," and "peripartum." Publications with 3 or more patients were reviewed for quality using the Joanna Briggs Institute checklist for prevalence studies and case series. Results: After reviewing 143 publications, 9 observational studies met our inclusion criteria. Pooled prevalence of maternal survival was 77.2% (95% confidence interval [CI]: 64.1%-88.4%). Pooled prevalence of fetal survival was 69.1% (95% CI: 44.7%-89.8%). The level of heterogeneity across studies was low for both outcomes. Meta-regression did not reveal any correlation between pregnant women with pulmonary or cardiac indications and maternal survival. Individual patient data meta-regression demonstrated higher odds of survival for patients on venovenous ECMO compared to those on venoarterial ECMO that was close to statistical significance (odds ratio = 3.016, 95% CI: 0.901-11.144; P = .081) after adjusting for pregnancy status. Conclusions: Extracorporeal membrane oxygenation can be considered as an acceptable salvage therapy for pregnant and postpartum patients with critical cardiac or pulmonary illness.

Original languageEnglish
Article number0885066619892826
Pages (from-to)220-228
Number of pages9
JournalJournal of Intensive Care Medicine
Volume36
Issue number2
Early online date12 Dec 2019
DOIs
Publication statusPublished - Feb 2021

Keywords

  • extracorporeal
  • oxygenation
  • pregnant
  • postpartum
  • outcomes
  • maternal
  • fetal
  • venovenous
  • venoarterial
  • life support
  • RESPIRATORY-DISTRESS-SYNDROME
  • LIFE-SUPPORT
  • FAILURE

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