Clinical application of extracorporeal membrane oxygenation in the treatment of critically ill pregnant women

doi:10.3877/cma.j.issn.1673-5250.2026.05.007

Objective

To explore the application of extracorporeal membrane oxygenation (ECMO) technology in the treatment of critically ill obstetric patients.

Methods

Six critically ill pregnant women treated with ECMO at Shenzhen People′s Hospital from January 1, 2020, to May 31, 2025, were selected as the study subjects. A retrospective analysis was conducted on the clinical data of the six cases to summarize ECMO indications, complications, and maternal and fetal outcomes. This study was approved by the Medical Ethics Committee of Shenzhen People′s Hospital (Approval No. LL-KY-2026273-01).

Results

The indications for ECMO in this study included one case of cardiogenic shock, one case of severe pneumonia caused by aspiration during cesarean section, three cases of pulmonary hypertension crisis, and one case of cardiac arrest. Five cases used venoarterial (VA)-ECMO, while one case used venovenous (VV)-ECMO. The ECMO initiation times were 2 cases before delivery, 1 case during delivery, and 3 cases after delivery. Complications during ECMO treatment included three cases of pneumonia, one case of amputation due to ischemic necrosis in the left lower limb, two cases of pulmonary hemorrhage, one case of gastrointestinal bleeding accompanied by airway bleeding, and one case of arteriovenous fistula (superficial femoral artery and great saphenous vein on the right side) with incision infection at the puncture site, and decreased muscle strength in both lower limbs.Among the six patients, one case was with a twin pregnancy, and the other five were singleton pregnancy. The hospitalization duration for the six patients ranged from 28 to 126 days, with a median of 71.5 days. Regarding maternal outcomes, five patients recovered and were discharged, while one died due to pulmonary hypertension crisis. The neonatal outcomes were one stillbirth, and the remaining six were live births, all of whom recovered well with active neonatal treatments.

Conclusion

ECMO helps to reduce the mortality rate of critically ill pregnant women and provides a foundation for further treatment.

Key words: Extracorporeal membrane oxygenation, Critical illness, Respiratory insufficiency, Heart failure, Pregnancy outcome, Pregnant people

表1 本研究危重孕产妇临床资料比较

患者编号	年龄(岁)	孕次、产次	分娩孕龄(周)	既往分娩方式	本次分娩方式	妊娠并发症
1	26	G₃P₁	27^＋4	阴道分娩	阴道分娩	重症肺炎，心室颤动，心源性休克
2	29	G₂P₁	35^＋6	阴道分娩	剖宫产	子痫前期，双胎妊娠，择期剖宫产术中发生误吸导致重症肺炎
3	24	G₂P₀	33	无	剖宫产	重度肺动脉高压，肺动脉高压危象；先天性心脏病：室间隔缺损修补术后、右心扩大、三尖瓣及肺动脉瓣中度返流
4	19	G₁P₀	31^＋4	无	剖宫产	重度肺动脉高压，肺动脉高压危象；先天性心脏病：室间隔缺损可能
5	35	G₂P₁	35^＋3	阴道分娩	剖宫产	重度肺动脉高压，肺动脉高压危象，全心衰
6	24	G₁P₀	32^＋4	无	剖宫产	心搏骤停；先天性心脏病：三尖瓣重度反流、房间隔缺损、心功能Ⅳ级；重度肺动脉高压
患者编号	ECMO使用指征	ECMO类型	ECMO启用时间	ECMO持续使用时间(d)	ECMO治疗期内并发症	患者结局	新生儿结局	患者住院时间(d)
1	心源性休克	VA-ECMO	分娩前	42	左下肢血栓、坏死而行左大腿截肢术；消化道出血，气道出血	康复出院	死胎	126
2	重症肺炎	VV-ECMO	分娩后	22	无	康复出院	双胎均存活	61
3	肺动脉高压危象	VA-ECMO	分娩后	22	肺出血	死亡	存活	28
4	肺动脉高压危象	VA-ECMO	分娩后	48	肺炎	康复出院	存活	82
5	肺动脉高压危象	VA-ECMO	分娩前	20	肺出血，肺炎	康复出院	存活	57
6	心搏骤停	VA-ECMO	分娩时	48	动静脉瘘(右侧股浅动脉与右侧大隐静脉)；穿刺点切口感染；双下肢肌力减退；肺炎	康复出院	存活	113

表1 本研究危重孕产妇临床资料比较

患者编号	年龄(岁)	孕次、产次	分娩孕龄(周)	既往分娩方式	本次分娩方式	妊娠并发症
1	26	G₃P₁	27^＋4	阴道分娩	阴道分娩	重症肺炎，心室颤动，心源性休克
2	29	G₂P₁	35^＋6	阴道分娩	剖宫产	子痫前期，双胎妊娠，择期剖宫产术中发生误吸导致重症肺炎
3	24	G₂P₀	33	无	剖宫产	重度肺动脉高压，肺动脉高压危象；先天性心脏病：室间隔缺损修补术后、右心扩大、三尖瓣及肺动脉瓣中度返流
4	19	G₁P₀	31^＋4	无	剖宫产	重度肺动脉高压，肺动脉高压危象；先天性心脏病：室间隔缺损可能
5	35	G₂P₁	35^＋3	阴道分娩	剖宫产	重度肺动脉高压，肺动脉高压危象，全心衰
6	24	G₁P₀	32^＋4	无	剖宫产	心搏骤停；先天性心脏病：三尖瓣重度反流、房间隔缺损、心功能Ⅳ级；重度肺动脉高压
患者编号	ECMO使用指征	ECMO类型	ECMO启用时间	ECMO持续使用时间(d)	ECMO治疗期内并发症	患者结局	新生儿结局	患者住院时间(d)
1	心源性休克	VA-ECMO	分娩前	42	左下肢血栓、坏死而行左大腿截肢术；消化道出血，气道出血	康复出院	死胎	126
2	重症肺炎	VV-ECMO	分娩后	22	无	康复出院	双胎均存活	61
3	肺动脉高压危象	VA-ECMO	分娩后	22	肺出血	死亡	存活	28
4	肺动脉高压危象	VA-ECMO	分娩后	48	肺炎	康复出院	存活	82
5	肺动脉高压危象	VA-ECMO	分娩前	20	肺出血，肺炎	康复出院	存活	57
6	心搏骤停	VA-ECMO	分娩时	48	动静脉瘘(右侧股浅动脉与右侧大隐静脉)；穿刺点切口感染；双下肢肌力减退；肺炎	康复出院	存活	113

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