The role of ECMO in acute intrapartum or postpartum events during cesarean section: A scoping review

IF 1.4 Q3 ANESTHESIOLOGY
Kamal Kumar, Sofía Zhang-Jiang, Malcolm Howard, Sonny Cheng, Cheng Lin
{"title":"The role of ECMO in acute intrapartum or postpartum events during cesarean section: A scoping review","authors":"Kamal Kumar,&nbsp;Sofía Zhang-Jiang,&nbsp;Malcolm Howard,&nbsp;Sonny Cheng,&nbsp;Cheng Lin","doi":"10.1016/j.tacc.2025.101573","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Peripartum obstetric emergencies, such as amniotic fluid embolism, massive hemorrhage or peripartum cardiomyopathy, can result in hemodynamic collapse and multi-organ failure. Extracorporeal membrane oxygenation (ECMO) offers temporary cardiopulmonary support by facilitating gas exchange and circulatory support in above situations. This review aims to evaluate the role and outcomes of ECMO use during acute intrapartum or early postpartum hemodynamic instability in patients undergoing Caesarean section.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted using PubMed, Embase, Medline, and Cochrane Central databases to identify relevant studies published up to January 2025. Inclusion criteria encompassed case reports and case series describing the use of ECMO in obstetric patients experiencing hemodynamic collapse during or within 24 h of Caesarean section. Exclusion criteria included non-obstetric patients, ECMO initiated beyond the early postpartum period, and studies without outcome data. A total of 18 publications reporting on 20 individual patients were included.</div></div><div><h3>Results</h3><div>Amniotic fluid embolism was the most frequently reported indication for ECMO use. The mean duration of ECMO support was 4.2 days. Twelve patients required mechanical ventilation for a mean of 15.3 days. Maternal survival was high, with only one reported death. Ten patients experienced uneventful recoveries. Among the survivors, four reported neurological sequelae, such as weakness and neurocognitive dysfunction.</div></div><div><h3>Conclusion</h3><div>Our results suggest that extracorporeal membrane oxygenation use in the obstetric population for hemodynamic collapse during or immediately following Caesarean section is associated with good maternal survival to discharge. Despite the severity of presentation, maternal survival to hospital discharge was favorable. Further prospective studies are needed to better define patient selection, timing, and long-term outcomes in this population.</div></div>","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"63 ","pages":"Article 101573"},"PeriodicalIF":1.4000,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Trends in Anaesthesia and Critical Care","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2210844025000577","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Background

Peripartum obstetric emergencies, such as amniotic fluid embolism, massive hemorrhage or peripartum cardiomyopathy, can result in hemodynamic collapse and multi-organ failure. Extracorporeal membrane oxygenation (ECMO) offers temporary cardiopulmonary support by facilitating gas exchange and circulatory support in above situations. This review aims to evaluate the role and outcomes of ECMO use during acute intrapartum or early postpartum hemodynamic instability in patients undergoing Caesarean section.

Methods

A comprehensive literature search was conducted using PubMed, Embase, Medline, and Cochrane Central databases to identify relevant studies published up to January 2025. Inclusion criteria encompassed case reports and case series describing the use of ECMO in obstetric patients experiencing hemodynamic collapse during or within 24 h of Caesarean section. Exclusion criteria included non-obstetric patients, ECMO initiated beyond the early postpartum period, and studies without outcome data. A total of 18 publications reporting on 20 individual patients were included.

Results

Amniotic fluid embolism was the most frequently reported indication for ECMO use. The mean duration of ECMO support was 4.2 days. Twelve patients required mechanical ventilation for a mean of 15.3 days. Maternal survival was high, with only one reported death. Ten patients experienced uneventful recoveries. Among the survivors, four reported neurological sequelae, such as weakness and neurocognitive dysfunction.

Conclusion

Our results suggest that extracorporeal membrane oxygenation use in the obstetric population for hemodynamic collapse during or immediately following Caesarean section is associated with good maternal survival to discharge. Despite the severity of presentation, maternal survival to hospital discharge was favorable. Further prospective studies are needed to better define patient selection, timing, and long-term outcomes in this population.

Abstract Image

ECMO在剖宫产术中急性产时或产后事件中的作用:范围回顾
背景围产期产科急诊,如羊水栓塞、大出血或围产期心肌病,可导致血流动力学衰竭和多器官衰竭。在上述情况下,体外膜氧合(ECMO)通过促进气体交换和循环支持提供临时心肺支持。本综述旨在评估ECMO在剖宫产患者急性产时或产后早期血流动力学不稳定时的作用和结果。方法采用PubMed、Embase、Medline和Cochrane Central数据库进行综合文献检索,筛选截至2025年1月发表的相关研究。纳入标准包括病例报告和病例系列,描述了在剖腹产期间或24小时内发生血液动力学衰竭的产科患者使用ECMO的情况。排除标准包括非产科患者、产后早期以后开始的ECMO和没有结果数据的研究。共纳入了18篇报道20例个体患者的出版物。结果羊水栓塞是ECMO最常见的适应症。ECMO支持的平均持续时间为4.2天。12例患者需要机械通气,平均15.3天。产妇存活率很高,据报告只有一人死亡。10名患者顺利康复。在幸存者中,有4人报告了神经系统后遗症,如虚弱和神经认知功能障碍。结论我们的研究结果表明,在产科人群中使用体外膜氧合治疗剖宫产术中或术后血液动力学衰竭可提高产妇的生存率。尽管病情严重,但产妇存活至出院是有利的。需要进一步的前瞻性研究来更好地确定该人群的患者选择、时间和长期结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
1.90
自引率
13.30%
发文量
60
审稿时长
33 days
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信