Extracorporeal Membrane Oxygenation in Peripartum Patients

While rare, extracorporeal membrane oxygenation (ECMO) use in peripartum patients experiencing severe cardiac or respiratory failure has been increasing in frequency, particularly for the management of COVID-19. Because it remains rare, there is limited evidence to help guide clinical decision-making in this population. The peripartum period presents unique physiologic challenges, including altered hemodynamics, increased risk of hemorrhage, and the need to consider both maternal and fetal outcomes. Wong et al¹ aim to address a gap in the literature by describing institutional strategies and outcomes and contribute valuable real-world evidence to inform multidisciplinary critical care and obstetric management.

The single-center case series included 18 peripartum (20 weeks to 6 weeks postpartum) patients who required ECMO between 2018 and 2023. The majority of cases involved respiratory failure, with over half (55%) associated with COVID-19 infection. All patients were placed on ECMO as a bridge to recovery, of which 14 (78%) patients survived to be discharged from the hospital. No patients received an organ transplant or durable mechanical device.

Maternal complications including infection (25%), postpartum hemorrhage (22%), oxygenator failure, hemolysis, or the need for an ECMO circuit change were the most common circuit complications observed, highlighting the significant risks associated with ECMO in this population. Despite these risks, outcomes were favorable compared with outcomes of ECMO in nonpregnant patients. The authors conclude that ECMO can be an effective lifesaving intervention in peripartum patients when managed by a coordinated multidisciplinary team. They emphasize the importance of careful patient selection, continuous reassessment, and awareness of pregnancy-specific complications when implementing ECMO support. 
 
This article is particularly relevant to critical care practice because it highlights the complexity of managing critically ill obstetric patients and the importance of interdisciplinary collaboration. The current data are supportive of ECMO for cardiopulmonary support in pregnancy; however, this is still an extremely limited area of study. There is minimal data in the literature regarding outcomes of different management strategies among peripartum patients (eg, cannulation sites, indications and timing of intervention, timing of delivery, independent outcomes of venoarterial or venovenous cannulation in the general population). This study is a valuable addition to the overall body of data on this topic, and the limitations laid out by the authors provide an opportunity to further study more nuanced aspects of care for peripartum patients being considered for cannulation or managed on ECMO. 


Reference

1. Wong RW, Seasely AR, Gongora E, et al. Strategies and outcomes of extracorporeal membrane oxygenation use in peripartum patients: a single institution experience. J Matern Fetal Neonatal Med. 2024 Dec;37(1):2355293.