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

Author:

Zhang John J. Y.1ORCID,Ong Jamie Ann-Hui1,Syn Nicholas L.1,Lorusso Roberto2,Tan Chuen Seng1,MacLaren Graeme13,Ramanathan Kollengode13

Affiliation:

1. Yong Loo Lin School of Medicine, National University of Singapore, Singapore

2. Cardio-Thoracic Surgery Department, Heart and Vascular Center, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands

3. Department of Cardiac Thoracic and Vascular Surgery, National University Heart Centre, National University Hospital, Singapore

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.

Publisher

SAGE Publications

Subject

Critical Care and Intensive Care Medicine

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