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Extracorporeal Life Support in Pregnancy: A Systematic Review and Meta-analysis
Abstract Number: T1B-184
Abstract Type: Original Research
Cardiovascular disease is the leading cause of pregnancy-related mortality contributing to more than a quarter (26%) of maternal deaths(1). Extracorporeal life support (ECLS) can support patients through either cardiac or respiratory failure and its use has increased and expanded substantially in the last decade. While uncommon, it has been successfully utilized in the peripartum period. The reported survival rate for pregnant patients undergoing ECLS is significantly higher than the overall survival with adult ECLS for pulmonary (59%) or cardiac (42%) causes with maternal survival rates ranging from 70-80% and fetal survival rates 65-72%(2-6).
The aim of this systematic review is to perform a comprehensive search of ECLS in the pregnant, peripartum, and postpartum periods and to define the reported indications, timing, management strategies, population specific considerations, and outcomes.
OVID MEDLINE, Embase, Web of Science, and CINAHL databases were searched to capture studies regarding ECLS in the pregnant, peripartum, and postpartum periods. Data was collected for indication, maternal demographics, gestation, timing, duration, and type of ECLS, and maternal and fetal morbidity and mortality.
Overall 2116 studies were identified and reviewed and 234 studies met inclusion criteria. There were a total of 334 cases of ECLS during the peripartum period reported including 35 deliveries on ECLS and 11 cases including cardiopulmonary bypass pre- or post-ECLS. There were 83 (24.9%) cases in the antepartum period, 80 (24.0%) cases intrapartum (<1 day), and 117 (35%) cases in the postpartum period (1-42 days). The most common indications for ECLS overall in pregnancy included ARDS (45.1%), cardiac failure (34.9%), and cardiac arrest (15.8%). The maternal survival was 253 (75.8%) and fetal survival was 159 (74.3%). The most common maternal complications included moderate bleeding (32.3%), severe bleeding requiring surgical intervention (14.1%) and vascular complications (4.2%). The most commonly reported fetal complications include preterm delivery in 71 (33.2%) and NICU admission in 55 (25.7%).
ECLS in the peripartum period demonstrates value and reasonable safety in this population and should be considered in cases of refractory respiratory failure, cardiogenic shock, cardiac arrest, septic and/or obstructive shock. These results may be limited by publication bias. Nevertheless, the current literature favors the implementation of ECLS in pregnant patients with severe morbidity as an effective therapy.
1. Creanga AA et al. Obstet Gyn 2017.
2. Sharma NS et al. Asaio 2015.
3. Anselmi A et al. J Card Surg 2015.
4. Saad AF et al. Obstet Gynecol 2016.
5. Moore SAet al. J Thorac Cardiovasc Surg 2016.
6. ELSO Registry Report. Accessed 2/3/19 at https://www.elso.org/Registry/Statistics/InternationalSummary.aspx.