What question did this study set out to answer?

This research aims to evaluate the use of ECMO in managing ARDS during pregnancy.

January 10, 2026Cureus0 citationsOpen Access

Extracorporeal Membrane Oxygenation (ECMO) for Acute Respiratory Distress Syndrome (ARDS) During Pregnancy: A Systematic Review

IKIslam Kourampi EXEleni Xourgia AEAristomenis K. Exadaktylos

Key Points

This research aims to evaluate the use of ECMO in managing ARDS during pregnancy.
Conducted a systematic review of existing literature on ECMO and ARDS in pregnancy.

Structured PICO

Does extracorporeal membrane oxygenation (ECMO) improve maternal and fetal survival in pregnant women with acute respiratory distress syndrome (ARDS)?

Population

Pregnant women with acute respiratory distress syndrome (ARDS) of any etiology who received ECMO support (13 observational studies and case series).

Intervention

Extracorporeal membrane oxygenation (ECMO), predominantly venovenous (VV) but also venoarterial (VA) configurations.

Outcome

Maternal survival and morbidity, fetal survival and neonatal outcomeshard clinical

ECMO is a feasible and often effective rescue therapy for refractory ARDS during pregnancy, though it is associated with considerable maternal morbidity and risks of extreme prematurity.

Abstract

Acute respiratory distress syndrome (ARDS) in pregnancy is rare but life-threatening. Extracorporeal membrane oxygenation (ECMO) has been used as rescue therapy in refractory cases, though evidence remains limited. This systematic review aimed to synthesize maternal and neonatal outcomes, describe complications, and evaluate study quality to inform clinical practice and research. A comprehensive search of MEDLINE, Embase, and Cochrane databases, through May 28, 2025, identified observational studies and case series reporting ECMO use for ARDS during pregnancy or the postpartum period. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Newcastle-Ottawa Scale (NOS) for cohorts and the Joanna Briggs Institute (JBI) checklist for case series. Thirteen studies published between 2011 and 2024 were included, most involving venovenous (VV) ECMO. Maternal survival ranged from 33% to 100%, with larger and more recent series reporting survival exceeding 80%. Major complications included bleeding, thromboembolism, infection, and acute kidney injury. Fetal outcomes were strongly influenced by gestational age at ECMO initiation, and neonatal morbidity largely reflected the degree of prematurity. The overall risk of bias was moderate to high across most studies. In conclusion, ECMO can be lifesaving for pregnant and postpartum patients with refractory ARDS, but current evidence is constrained by observational designs, small sample sizes, and heterogeneity in reporting. Standardized data collection, prospective registries, and collaborative multicenter studies are needed to better define the safety, timing, and long-term outcomes of ECMO use in this unique patient population.

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