Delivery During ECMO: A Single-Center Case Series

Purpose: Extracorporeal membrane oxygenation (ECMO) is the standard of care for temporary life support in potentially reversible cardiac or respiratory failure. Here we report our experience with ECMO as a “bridge-to-delivery” in pregnants. Methods: 4 patients underwent caesarean section during ECMO. Mean age was 34±3 years and body surface area was 1.71±0.1 m2. Gestation week at the time of ECMO implant was 31±2 weeks. The indications for ECMO were: severe pulmonary hypertension in 2 patients, severe respiratory failure (influenza H1N1) in 1 patient, cardiogenic shock complicating mechanical mitral prosthesis thrombosis in 1 patient. A low anticoagulation rate was maintained during ECMO. Heparin was stopped during the caesarean section. Local anesthesia was administered for peripheral cannulation. Results: See tables. Conclusion: ECMO was a safe and effective support during pregnancy, with 100% survival of mothers and fetuses. The incidence of complications during shorter ECMO runs was low, whereas the longer run caused more severe complications and less favorable outcome for the fetus. 50% of the mothers and 25% of the fetuses experienced bleeding complications despite low anti- coagulation rate. Local anesthesia was well tolerated and allowed to avoid the hemodynamic changes typical of general anesthesia.