Extracorporeal life support (ECLS) has become increasingly common in the United States to manage refractory cardiopulmonary failure and has been used in complex populations including pregnant women. Application of ECLS to antepartum cardiopulmonary arrest is particularly unique because therapy affects two patients, the mother and the fetus. Therefore, evaluating the outcomes for both the mother and fetus is important to assess the potential benefits and harms of ECLS in this population. Previous data on the use of ECLS for antepartum shock have shown favorable short-term outcomes in pregnant women, with lower in-hospital morbidity and mortality compared to other patients undergoing ECLS, although in-hospital mortality in the antepartum period remained high at approximately 30%.¹ Regarding short-term neonatal outcomes, data collected predominantly from case reports identified that the use of maternal ECLS at a median gestational age of 24 weeks resulted in approximately 35% in-hospital infant mortality.² Although such short-term evaluation of in-hospital outcomes is important, evaluation of posthospitalization outcomes among children born to mothers requiring antepartum ECLS is likewise critical.

In this issue of ASAIO Journal, Seadler et al.³ describe a case series of seven women undergoing ECLS during pregnancy, with a specific focus on in-hospital and posthospital neonatal outcomes. Indication for ECLS was cardiogenic shock in one woman and respiratory failure in six women, with four undergoing veno-venous extracorporeal membrane oxygenation (V-V ECMO), two undergoing veno-pulmonary arterial (V-A ECMO), and one undergoing V-A ECMO with a percutaneous left ventricular assist device. The median gestational age at ECLS initiation was 27 weeks and median gestational age at delivery was 29 weeks, with 6 of 7 neonates delivered while on maternal ECLS. All neonates underwent operative delivery and had a median birth weight of 1.4 kg. Neonatal predischarge morbidity included the need for invasive mechanical ventilation in five neonates, bronchopulmonary dysplasia in three neonates, and patent ductus arteriosus in one neonate. All mothers and all neonates survived to discharge with a median neonatal hospitalization duration of 56 ± 21 days. The authors were able to follow the neonates for a mean postdischarge duration of 1.4 ± 1.2 years. During follow-up, one child required rehospitalization, for otitis media. Four children underwent neurodevelopmental testing, with two children demonstrating mild-moderate delays related to speech and language. The authors concluded that maternal ECLS is associated with high maternal and neonatal survival, and with favorable intermediate-term neonatal morbidity possibly as expected for gestational age.