Extracorporeal membrane oxygenation in pregnancy: a bridge to delivery and pulmonary recovery for COVID-19–related severe respiratory failure

Yin, Ophelia; Richley, Michael; Hadaya, Joseph; Mei, Jenny Y.; Mok, Thalia; Fahim, Mariam; Pluym, Ilina D.; Rao, Rashmi; Martin, Courtney; Han, Christina S.; Benharesh, Peyman; Afshar, Yalda

doi:10.1016/j.ajog.2021.12.024

Cited by 12 publications

(13 citation statements)

References 6 publications

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“…In the presented case, the decision that was determined was to place VV ECMO after assessing the state of refractory hypoxemia and the lack of response to the rest of the treatments. Published case reports of pregnant women with severe COVID-19 disease who were supported with VV ECMO describe satisfactory outcomes [ 4 , 12 , 24 , 25 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

Severe COVID-19 Infection during Pregnancy Requiring ECMO: Case Report and Review of the Literature

Diago-Muñoz

Martínez-Varea

Pérez-Sancho

et al. 2023

JPM

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The risk of developing severe COVID-19 that requires admission to an intensive care unit (ICU) and invasive ventilation is increased in pregnant women. Extracorporeal membrane oxygenation (ECMO) has been successfully used to manage critical pregnant and peripartum patients. Case Report: A 40-year-old patient, unvaccinated for COVID-19, presented to a tertiary hospital in January 2021 at 23 weeks of gestation due to respiratory distress, cough, and fever. The patient had a confirmed diagnosis of SARS-CoV-2 with a PCR test in a private center 48 hours before. She required admission into the ICU due to respiratory failure. High-flow nasal oxygen therapy, intermittent noninvasive mechanical ventilation (BiPAP), mechanical ventilation, prone positioning, and nitric oxide therapy were administered. Additionally, hypoxemic respiratory failure was diagnosed. Thus, circulatory assistance using ECMO with venovenous access was performed. After 33 days of ICU admission, the patient was transferred to the internal medicine department. She was discharged 45 days after hospital admission. At 37 weeks of gestation, the patient presented active labor and underwent an uneventful vaginal delivery. Conclusions: Severe COVID-19 in pregnancy may lead to the requirement for ECMO administration. This therapy should be administered in specialized hospitals using a multidisciplinary approach. COVID-19 vaccination should be strongly recommended to pregnant women to decrease the risk of severe COVID-19.

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Section: Discussionmentioning

confidence: 99%

Severe COVID-19 Infection during Pregnancy Requiring ECMO: Case Report and Review of the Literature

Diago-Muñoz

Martínez-Varea

Pérez-Sancho

et al. 2023

JPM

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“…In both cases, there were severe complications of ECMO. In one case, concern for hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome or abruptio placentae after the initiation of ECMO resulted in an emergency cesarean section [ 10 ]. In the other case, there was recannulation after weaning off ECMO and delivery [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Subsequently, there have been multiple reports of pregnant women infected with severe COVID-19. While it has been reported that extracorporeal membrane oxygenation (ECMO) therapy is useful for severe COVID-19 pneumonia, the optimal timing for the initiation of ECMO and whether or not to continue the pregnancy in women with severe COVID-19 pneumonia remains unclear, as the risk and benefit to both mother and fetus need to be considered [3][4][5][6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Successful Outcome of Mother and Baby in a Woman With Severe COVID-19 Pneumonia in the Third Trimester of Pregnancy Who Required Extracorporeal Membrane Oxygenation Therapy

Asano¹,

Tanigaki²,

Sato³

et al. 2023

Cureus

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Some studies have reported increased severe coronavirus disease (COVID-19) infection in the third trimester of pregnancy. Therefore, prenatal care in the third trimester requires careful judgment. It has been reported that extracorporeal membrane oxygenation (ECMO) therapy is useful for severe coronavirus disease 2019 (COVID-19) pneumonia; however, the optimal timing for the initiation of ECMO is controversial because the risks and benefits to the mother and fetus require careful consideration. We report a good outcome for mother and baby in a pregnant woman with severe COVID-19 pneumonia at 29 weeks gestation, who underwent urgent delivery and required ECMO therapy.A 34-year-old woman tested positive for COVID-19 at 27 weeks gestation. Despite treatment with remdesivir and prednisolone, her respiratory condition worsened. Consequently, she underwent emergent endotracheal intubation at 28 weeks and 2 days. Although the PaO 2 /FiO 2 (P/F ratio) improved temporarily after endotracheal intubation, her respiratory condition progressively worsened. At 29 weeks gestation, an emergency cesarean section was performed and ECMO was initiated the next day. Although hematoma was observed after ECMO initiation, her respiratory condition improved. She was discharged home 54 days after the cesarean delivery without any complications. The neonate was intubated and transferred to the neonatal intensive care unit and was ultimately discharged home without any complications.Considering the risks and benefits of ECMO for the mother and fetus in the third trimester, ECMO should be initiated after delivery for better outcomes. The P/F ratio may be useful for an appropriate decision regarding delivery and the initiation of ECMO.

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“… 4 ECMO has been described in multiple case reports as an effective bridge to recovery for patients with severe respiratory distress syndrome in the setting of COVID-19 infection. 5) , 6) , 7) , 8) , 9) This review aims to describe ECMO use in pregnancy in the setting of COVID-19 infection.…”

Section: Introductionmentioning

confidence: 99%

Extracorporeal membrane oxygenation in pregnancy during the SARS-CoV-2 pandemic

Richley¹,

Rao²

2023

Seminars in Fetal and Neonatal Medicine

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Extracorporeal membrane oxygenation in pregnancy: a bridge to delivery and pulmonary recovery for COVID-19–related severe respiratory failure

Cited by 12 publications

References 6 publications

Severe COVID-19 Infection during Pregnancy Requiring ECMO: Case Report and Review of the Literature

Severe COVID-19 Infection during Pregnancy Requiring ECMO: Case Report and Review of the Literature

Successful Outcome of Mother and Baby in a Woman With Severe COVID-19 Pneumonia in the Third Trimester of Pregnancy Who Required Extracorporeal Membrane Oxygenation Therapy

Extracorporeal membrane oxygenation in pregnancy during the SARS-CoV-2 pandemic

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