Venovenous extracorporeal membrane oxygenation (VV-ECMO) is often used for lung rest in critically ill patients, including pregnant patients.

We aimed to determine how pregnant and non-pregnant patients requiring VV-ECMO differed from each other and how pregnancy impacted in-hospital mortality.

We used the National Inpatient Sample to identify a cohort of female patients requiring VV-ECMO from 2016 to 2021, stratified by pregnancy status. Baseline characteristics were compared using Pearson chi-square test. Predictors of in-hospital mortality, including pregnancy and complications from VV-ECMO, were determined using multivariate analysis with a logistic regression model.

Of 7365 female patients requiring VV-ECMO, 700 (9.5 %) were pregnant. Pregnant patients were younger. COVID-19 was more prevalent in pregnant patients (72.9 % versus 36.4 %, p < 0.001). Infectious complications were more common in non-pregnant patients (64.1 % versus 43.6 %, p < 0.001). Pregnant patients suffered from less in-hospital mortality (20.0 % versus 38.5 %, p < 0.001), and pregnancy predicted survival (adjusted odds ratio (OR): 0.49 [0.27–0.89], p = 0.02). Length of stay ≥7 days and COPD were associated with reduced odds of in-hospital mortality; chronic heart failure, COVID-19, and VV-ECMO complications were associated with increased odds of in-hospital mortality.

These findings underscore the unique clinical profile and outcomes of pregnant females requiring VV-ECMO, highlighting the need for tailored management strategies. Prospective studies are essential to validate these observations and optimize care for this vulnerable patient population.