title: Extracorporeal life support during pregnancy.
abstract: OBJECTIVE
  To review the literature on extracorporeal life support (ECLS) during pregnancy to determine its efficacy and safety for the mother and fetus.
  
  
  METHODS
  A comprehensive literature search was obtained from MEDLINE via PubMed.gov and from ScienceDirect.com using the following search queries: ECLS and pregnancy, extracorporeal membrane oxygenation (ECMO) and pregnancy, ECMO and H1N1 influenza, acute respiratory distress syndrome (ARDS) and pregnancy, pregnancy and H1N1 influenza, and Extracorporeal Life Support Organization registry.
  
  
  RESULTS
  Our literature search produced 332 articles for review. A total of 45 patients treated with ECLS or ECMO during pregnancy were reported in 26 publications. Postpartum patients were not included. Indications for ECLS were severe H1N1 influenza with ARDS (n = 33), other ARDS (n = 8), cardiogenic shock (n = 3), and cardiac arrest (n = 1). The mean gestational age was 26.5 weeks (range, 12-38 weeks), and the median duration of ECLS was 12.2 days (range, 1-57 days). The survival rate was 77.8% (35 of 45) for mothers and 65.1% (28 of 43) for fetuses. In addition, we report a 25-year-old pregnant patient with hantavirus cardiopulmonary syndrome unresponsive to pressors and inotropes. The patient was placed on venoarterial ECMO for 72 hours, recovered without complications, and delivered a healthy infant. The mother and son remain asymptomatic 6 years later.
  
  
  CONCLUSIONS
  ECLS during pregnancy is effective and relatively safe for the mother and fetus. The first successful use of ECLS in a pregnant patient with life-threatening hantavirus cardiopulmonary syndrome is being reported together with this review.
authors.affiliation: Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, NM.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Moore
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, NM. Electronic address: cdietl@comcast.net.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Dietl
authors.affiliation: Division of Pediatric Critical Care, Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM.
authors.forename: Denise M
authors.initials: DM
authors.lastname: Coleman
mesh_terms: D000328:Adult; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects; D005260:Female; D006476:Orthohantavirus / Q000472:pathogenicity; D018804:Hantavirus Pulmonary Syndrome / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy* / Q000821:virology; D006801:Humans; D007231:Infant, Newborn; D053118:Influenza A Virus, H1N1 Subtype / Q000472:pathogenicity; D007251:Influenza, Human / Q000150:complications / Q000821:virology; D050498:Live Birth; D008297:Male; D016017:Odds Ratio; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy* / Q000821:virology; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy* / Q000821:virology; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
keywords: circulatory temporary support; extracorporeal membrane oxygenation; pregnancy