Extracorporeal membrane oxygenation in pregnant and postpartum patients: a systematic review

Information on the use of extracorporeal membrane oxygenation (ECMO) in obstetric patients is scarce. The objective was to conduct a systematic review examining ECMO use in pregnant and postpartum patients in order to identify indications leading to ECMO use and to assess mortality rates. PubMed, EMBASE, Cochrane Library, and SCOPUS were searched using the terms “extracorporeal membrane oxygenation” and “pregnancy” up to 1 November 2020. Case reports and case series reporting the use of ECMO in pregnancy were eligible. Data about maternal age, gestational age, diagnosis, type of ECMO, time on ECMO, pregnancy outcomes, and maternal survival were extracted from studies. The search yielded 1696 citations, of which 125 were included. There were 213 obstetric patients treated with ECMO over a 30-year period. The frequency of reports increased considerably over the last decade. The majority of patients were treated in their third trimester (28.2%) or postpartum (32.9%). Most common etiologies included influenza-induced ARDS (27.7%), pulmonary embolism (13.6%), peripartum cardiomyopathy (11.7%), and infection (11.7%). Pregnancy outcomes ended with live births, either on ECMO (15.5%, 95% CI 10.6–20.4) or not on ECMO (58.3%, 95% CI 51.7–64.9), in fetal demise (8.9%, 95% CI 5.1–12.7), or in spontaneous or induced abortion on ECMO (4.2%, 95% CI 1.5–6.9) or not on ECMO (4.2%, 95% CI 1.5–6.9). Maternal survival was 79.3%. Although women placed on ECMO had a high mortality rate, this is likely an indication of the severity of illness. Overall, ECMO appears to be a valid therapy for the temporary support of vital organs in severely ill pregnant women.

产科患者体外膜肺氧合（extracorporeal membrane oxygenation, ECMO）的临床应用相关研究数据目前较为匮乏。本研究旨在开展一项系统综述，针对妊娠及产后患者的ECMO应用情况进行分析，以明确其临床应用指征并评估患者病死率。研究检索了PubMed、EMBASE、Cochrane图书馆及SCOPUS数据库，检索时限截至2020年11月1日，检索词为"extracorporeal membrane oxygenation"与"pregnancy"。纳入符合标准的妊娠患者ECMO应用相关病例报告及病例系列研究，从纳入研究中提取产妇年龄、孕周、临床诊断、ECMO类型、ECMO支持时长、妊娠结局及产妇生存情况等数据。本次检索共获得1696条文献记录，最终纳入125项研究。30年间共有213名产科患者接受了ECMO治疗，近十年来相关研究报道的数量显著增长。多数患者于妊娠晚期（28.2%）或产后（32.9%）接受ECMO治疗。最常见的致病病因包括流感诱发的急性呼吸窘迫综合征（Acute Respiratory Distress Syndrome, ARDS，27.7%）、肺栓塞（13.6%）、围产期心肌病（11.7%）及感染（11.7%）。妊娠结局包括：ECMO支持下活产（15.5%，95%置信区间10.6%~20.4%）、非ECMO支持下活产（58.3%，95%置信区间51.7%~64.9%）、胎儿宫内死亡（8.9%，95%置信区间5.1%~12.7%），以及ECMO支持下自然流产或人工流产（4.2%，95%置信区间1.5%~6.9%）或非ECMO支持下自然流产或人工流产（4.2%，95%置信区间1.5%~6.9%）。产妇总体生存率为79.3%。尽管接受ECMO治疗的产妇病死率较高，但这大概率反映了其原发疾病的严重程度。总体而言，ECMO可作为重症妊娠患者生命器官临时支持的有效治疗手段。