A case of a pregnant patient with COVID‐19 infection treated with emergency c‐section and extracorporeal membrane oxygenation

Abstract

Coronavirus disease 2019 (COVID‐19) causes the development of severe acute respiratory distress syndrome. Pregnant women may be at increased risk for the development of severe disease. We present the case of a pregnant patient who developed respiratory failure due to COVID‐19 and rapidly decompensated requiring intubation. Despite mechanical ventilation, the patient's respiratory status continued to worsen. At bedside, cardiothoracic surgeons, obstetricians, intensivists, and neonatologists discussed balancing the risk of COVID‐19 and respiratory failure to the patient, premature delivery to the neonate, potential coagulopathy associated with COVID‐19, and the need for anticoagulation with mechanical circulatory support. Ultimately, the decision was to proceed with emergency cesarean section delivery in the intensive care unit followed by peri‐partum veno‐venous extracorporeal membrane oxygenation initiation. The patient and neonate were both discharged home in stable condition.

Extra-corporeal membrane oxygenation and emergency C-section for a pregnant COVID-19 positive patient

“…In a series by Barrantes et al, 8 nine COVID-19 positive patients required ECMO support and required cesarean sections either before or after ECMO cannulation. Rushakoff et al 1 also reported a case of a 30-yearold COVID-19 positive pregnant patient with a 29-week fetus taken first to emergency C-section followed by immediate v-v ECMO support. Additionally, in a report by Hou et al, 2 a third trimester COVID-19 positive patient had her pregnancy terminated followed by ECMO support.…”

“…1 Although pregnancy in itself does not increase the likelihood of acquiring COVID-19, the physiological changes associated with pregnancy may render pregnant women susceptible to severe respiratory distress and severe disease. 1,2 Here we present a case of a COVID-19 positive 36-year-old 26-week pregnant patient with respiratory failure requiring ECMO support and C-section while on ECMO. COVID-19 has presented many difficult decision-making scenarios for physicians.…”

“…Data on extra-corporeal membrane oxygenation (ECMO) therapy for pregnant patients with Coronavirus 2019 (COVID-19) infection is limited. 1 COVID-19 infection can lead to severe respiratory distress syndrome requiring mechanical ventilation and circulatory support. Pregnant patients fall into an especially vulnerable population where both mother and child are at increased risk for complications secondary to COVID-19.…”

“…Pregnant patients fall into an especially vulnerable population where both mother and child are at increased risk for complications secondary to COVID-19. 1 At the beginning of 2021, over 61,000 cases of COVID-19 positive pregnant women and over 10,000 hospitalized cases were confirmed in the United States. 1 Although pregnancy in itself does not increase the likelihood of acquiring COVID-19, the physiological changes associated with pregnancy may render pregnant women susceptible to severe respiratory distress and severe disease.…”

COVID-19-Related Acute Respiratory Distress Syndrome in a Pregnant Woman Supported on ECMO: The Juxtaposition of Bleeding in a Hypercoagulable State

“…Most reports are of individual cases or small case series, as a result of a limited number of patients and difficulty in conducting a randomized trial on peripartum ECMO support, specifically in COVID-19-infected pregnant patients. For example, an article by Rushakoff et al showed an identical situation, where the MDT involved in the management of their patient preferred to deliver her before ECMO deployment [ 11 ], while in another report, the patient continued her pregnancy and delivered after resolution of her acute illness [ 12 ].…”