title: Modern use of extracorporeal life support in pregnancy and postpartum.
abstract: Extracorporeal membrane oxygenation (ECMO) use during pregnancy and the postpartum period are thought to be associated with an increased risk for maternal or fetal bleeding complications. We present our recent institutional experience in managing pregnant and postpartum patients with ECMO. We also performed a literature review of modern use of ECMO in pregnant and postpartum patients utilizing Pubmed and Embase databases. ECMO was used for severe cardiopulmonary failure due to multiple conditions. Based on published reports, overall maternal and fetal survival on ECMO were 80% and 70%, respectively. Mild-to-moderate vaginal bleeding was reported in a few cases, with rare occurrences of catastrophic postpartum hemorrhage. There was no consensus on an optimal anticoagulation strategy in these patients, though most preferred to keep anticoagulation at lower therapeutic levels. We conclude that ECMO, in well-selected pregnant and postpartum patients, appears to be safe and associated with low risk of maternal and fetal complications.
authors.affiliation: From the *Division of Pulmonary, Critical Care, and Sleep Medicine, and the †Department of Cardiothoracic Surgery, University of Alabama, Birmingham, Alabama.
authors.forename: Nirmal S
authors.initials: NS
authors.lastname: Sharma
authors.forename: Keith M
authors.initials: KM
authors.lastname: Wille
authors.forename: Scott C
authors.initials: SC
authors.lastname: Bellot
authors.forename: Enrique
authors.initials: E
authors.lastname: Diaz-Guzman
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D001803:Blood Transfusion; D004619:Embolism, Amniotic Fluid / Q000628:therapy; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000628:therapy; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D011249:Pregnancy Complications, Cardiovascular / Q000628:therapy; D011256:Pregnancy Outcome; D011644:Puerperal Disorders / Q000628:therapy*; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000628:therapy; D012770:Shock, Cardiogenic / Q000150:complications / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants