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

Abstract

Abstract: Extracorporeal membrane oxygenation (ECMO) is a specialized technique providing temporary support for failed cardiac and respiratory functions. While commonly used in neonates and children, its application in obstetric patients is gaining traction. In hypoxemic and hypercapnic respiratory failure with intact cardiac function, Veno-Venous ECMO (VV-ECMO) offers artificial oxygenation and decarboxylation. This comprehensive article discusses VV-ECMO in obstetrics, covering prevalence, maternal and neonatal outcomes, mechanisms, protocols, access sites, indications, contraindications, anticoagulation, complications, and considerations. The VV-ECMO procedure involves redirecting blood from the heart or major veins through an artificial lung and back to the heart, improving oxygenation, respiratory mechanics, and cardiac function while reducing lung injury risk. Cannulation methods range from double-lumen to bi-femoral, depending on patient needs. Prevalence of VV-ECMO in pregnancy is 8.9%. Outcomes vary based on factors like medical condition and gestational age. Survival rates range from 63% to 76% for pregnant patients and 70% to 86% for infants. Common indications encompass severe H1N1 influenza, pre-eclampsia, and viral infections. Contraindications involve refusal, end-stage malignancy, and severe neurologic injury. Anticoagulation, crucial for preventing clotting in the ECMO circuit, primarily employs unfractionated heparin. Complications include bleeding, thrombosis, and infections. In pregnancy, similar indications exist, with VV-ECMO typically proving safe and effective for both maternal and fetal survival.