Extracorporeal Membrane Oxygenation in Pregnancy.

ABSTRACT

AIM: Adult respiratory distress syndrome (ARDS) may pose specific challenges in pregnant women, including the need for prone decubitus ventilation and extracorporeal membrane oxygenation (ECMO). We present our experience with ECMO during pregnancy and review the literature on this topic. METHODS: We performed a systematic literature review using the MEDLINE-NIH database. Papers describing single cases or clinical series of pregnant women treated with veno-venous ECMO for ARDS were retrieved; the clinical features and maternal and infant outcomes were presented in aggregate form. RESULTS: We describe the case of a 32-year-old primigravida who received ECMO starting at the 28th gestation week due to A/H1N1 influenza-related ARDS. This strategy allowed saving both mother and child; normal recovery without sequelae was evident at one year. The systematic review included 29 reported cases of ECMO employment during pregnancy; A/H1N1 influenza was the etiology of ARDS in 79% of cases. Maternal and infant mortality may reach 28%, while the rate of complications during ECMO support reaches 57%. CONCLUSIONS: ECMO is a viable treatment for severe ARDS during pregnancy, after failure of other therapeutic strategies; the risk of spontaneous gynecological bleeding is limited. Issues remain about the timing of ECMO implantation and the management of gestation. Close fetal assessment and multidisciplinary discussion are pivotal for decision-making.