Veno-Arterial Extracorporeal Membrane Oxygenation in Pregnancy: A Literature Review

Abstract

Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) is a very important circulatory support system, and its use is increasing over the years especially in pregnancy and its related consequences on the mother and the fetus. This article is directed to review all the important aspects regarding VA-ECMO in pregnancy, addressing that it is less commonly used during pregnancy not disregarding maternal, neonatal, and long-term outcomes such as, the survival rate is relatively good compared to the general population adjusted to different causes mentioned in this article. A description of what VA-ECMO is, protocols, usual targeted goals, preferred sites of access especially peripheral cannulation, indications including multiple causes of cardiac failure, some contraindications majorly end-stage cardiac failure when recovery or transplant is not possible, the use of anticoagulation and its side effects, specific complications including bleeding from multiple sites, and the incidence of thromboembolic complications. Moreover, a good clarification and thorough discussion is intended for some of the special considerations and technical challenges in pregnancy due to uterine compression, maternal susceptibility for thrombosis and infections, the status of the fetus and the mode of delivery.