Efficacy And Safety Of Extracorporeal Membrane Oxygenation For Severe Acute Maternal Morbidity:A Case Series Meta-analysis And A Case Report

BACKGROUND Severe acute maternal morbidity patients are in a special situation of pathophysiology.As a ultimate method for resuscitation,Extracorporeal membrane oxygenation has lots of complications and consume a huge social medical resources.ECMO's use in severe acute maternal morbidity is still less than 30 years,most of relevant articles are individual case reports,there is still no evidence-based medicine analysis.OBJECTIVE To explore the efficacy and safety of ECMO's use in severe acute maternal morbidity from the perspective of evidence-based medicineMETHOD Our study collected all articles from 1997 to 2017 on ECMO's use in severe acute maternal morbidity.All chinese,english and french language were included.Document types including case reports,crosssectional studies,retrospective studies,prospective studies and controlled studies.The main indicators are: maternal and fetal/neonatal survival.The secondary indicators are: maternal and fetal/neonatal sequelae,ECMOrelated complications,changes in physiological parameters before/during/after ECMO,ECMO duration,ICU duration and hospital stay duraton.Datas were analyzed by using the method of individual patient data meta analysis.RESULT 84 individual patient datas were included.A Meta-analysis showed that the maternal survival rate was 89.75%,which was higher than that of all ECMO-supported adult patients(47.49%).Fetal/neonatal survival rate was 86.39%,maternal sequelae rate was 24.11%,fetal/neonatal sequelae rate was 3.18%,and maternal complications rate was 50.43%.The maternal survival rate of severe acute maternal morbidity patients rescued by ECMO was slightly lower than the maternal survival rate of all severe acute maternal morbidity patients,but was significantly higher than that of all patients ECMO-supported adult patients.Compared with all ECMOsupported adult patients,the complications rate in severe acute matermal morbidity patients was not significantly higher,the ECMO duration and the ICU duration is relatively short,and the maternal sequelae rate and the severity of sequelae is relatively lower.CONCLUSION The safety and efficacy of ECMO's use in severe acute maternal morbidity patients can be confirmed.