Background
The use of extracorporeal life support (
ECLS
) has expanded to include unique populations such as peripartum women. This systematic review aims to (1) quantify the number of cases and indications for
ECLS
in women during the peripartum period reported in the literature and (2) report maternal and fetal complications and outcomes associated with peripartum
ECLS
.
Methods and Results
This review was registered in
PROSPERO
(
CRD
42018108142).
MEDLINE
, Embase, and
CINAHL
were searched for case reports, case series, and studies reporting cases of
ECLS
during the peripartum period that reported one or more of the following outcomes: maternal survival, maternal complications, fetal survival, and/or fetal complications. Qualitative assessment of 221 publications evaluated the number of cases, clinical details, and maternal and fetal outcomes of
ECLS
during the peripartum period. There were 358 women included and 68 reported fetal outcomes in cases where the mother was pregnant at the time of cannulation. The aggregate maternal survival at 30 days was 270 (75.4%) and at 1 year was 266 (74.3%); fetal survival was 44 (64.7%). The most common indications for
ECLS
overall in pregnancy included acute respiratory distress syndrome 177 (49.4%), cardiac failure 67 (18.7%), and cardiac arrest 57 (15.9%). The most common maternal complications included mild to moderate bleeding 66 (18.4%), severe bleeding requiring surgical intervention 48 (13.4%), and intracranial neurologic morbidity 19 (5.3%). The most commonly reported fetal complications included preterm delivery 33 (48.5%) and neonatal intensive care unit admission 19 (27.9%).
Conclusions
Reported rates of survival in
ECLS
in pregnant and postpartum women are high and major complications relatively low.
