Extracorporeal Membrane Oxygenation for Pregnant and Postpartum Patients

Michael J. Wong, MD; Shobana Bharadwaj, MBBS; Jessica L. Galey, MD; Allison S. Lankford, MD; Samuel Galvagno, DO, PhD; Bhavani Shankar Kodali, MD

Disclosures

Anesth Analg. 2022;135(2):277-289. 

In This Article

Ethical Considerations

Critical care during pregnancy can be ethically complex and further complicated by ECMO support.[99–101] ECMO initiation is usually uncontroversial as a maternal bridge-to-survival or bridge-to-transplant during cardiopulmonary failure, and ECMO support helps continue the pregnancy in an effort to reduce fetal morbidity from prematurity.[27] However, later choices concerning withdrawal of care or prolonged maintenance of life support can be contentious, particularly when patient's wishes are unknown or when maternal and fetal goals are conflicting. For instance, ECMO has been used for pregnancy prolongation in the context of maternal brain death and extreme prematurity,[102] a scenario where the mother is rendered an instrument for fetal survival. In such instances, the International Federation of Gynecology and Obstetrics (FIGO) emphasizes that decisions around pregnancy prolongation be informed by anticipated fetal outcomes as well as known maternal wishes, or at least the wishes of their family.[103] In these ethically ambiguous and uncommon scenarios, palliative care and clinical ethics consultation help to identify shared goals and enhance communication.

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