Challenges and pitfalls of extracorporeal membrane oxygenation in critically-ill pregnant and peripartum women with COVID-19: a retrospective case series

Piwowarczyk, Paweł; Porzak, Mikołaj; Szczukocka, Marta; Karolina, KAZIRÓD,; Kwaśniewski, Wojciech; Czuczwar, Mirosław; Borys, Michał

doi:10.1016/j.ijoa.2023.103625

Cited by 7 publications

(26 citation statements)

References 20 publications

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“…After the elimination of studies not relevant to the subject of interest and meeting abstracts, 25 were retrieved for complete analysis. 4,6,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] Four studies were excluded: three for including duplicate patients published in other included articles [40][41][42] and one because of the inability to determine from published information the number of women with maternal mortality. 43 The corresponding authors for the latter study were contacted and indicated that they could not provide the additional information requested.…”

Section: Resultsmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation in Pregnant and Postpartum Women With Critical Coronavirus Disease 2019 (COVID-19) Acute Respiratory Distress Syndrome

Shamshirsaz,

Byrne,

Ramsey

et al. 2023

Obstetrics &Amp; Gynecology

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OBJECTIVE: To estimate the maternal survival and live-birth rates in pregnant women with acute respiratory distress syndrome (ARDS) secondary to critical coronavirus disease 2019 (COVID-19) who are treated with extracorporeal membrane oxygenation (ECMO) by performing a systematic review and meta-analysis. DATA SOURCES: From database inception through August 2023, we explored MEDLINE, Web of Science, EMBASE, CINAHL, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials. Studies reporting maternal survival and live-birth rates in pregnant women with critical COVID-19 undergoing ECMO were included. METHODS OF STUDY SELECTION: Two reviewers separately ascertained studies, obtained data, and evaluated study quality. Summary estimates of maternal survival and live-birth rates were measured, and 95% CIs were calculated. TABULATION, INTEGRATION, AND RESULTS: Nine retrospective case series and 12 retrospective cohort studies were identified with 386 pregnant women with critical COVID-19 who underwent ECMO. Studies evaluated women that were treated from January 2020 to October 2022. Four studies were from the United States; three were from Turkey; two were from France; two were from Israel; and one each was from Columbia, Germany, Italy, Kuwait, Poland, Republic of Srpska, the United Arab Emirates, the United Kingdom, a consortium from Belgium, France, Switzerland, and an international registry. The pooled estimate of the maternal survival rate among pregnant patients who were initiated on ECMO was 75.6% (95% CI, 66.0–84.1%, I 2=72%). The pooled estimate of the live-birth rate among pregnant patients who were initiated on ECMO was 83.7% (95% CI, 76.8-89.6%, 153 neonates, I 2=11%). When the case series and cohort studies were examined separately, the results were similar. CONCLUSION: Among pregnant women with acute respiratory distress syndrome attributable to critical COVID-19 who were managed with ECMO, maternal survival and live-birth rates were high. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42023442800.

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Section: Resultsmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation in Pregnant and Postpartum Women With Critical Coronavirus Disease 2019 (COVID-19) Acute Respiratory Distress Syndrome

Shamshirsaz,

Byrne,

Ramsey

et al. 2023

Obstetrics &Amp; Gynecology

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“…First, as the study included patients between 2010 and 2016, and although the incidence of use was stable during the period of inclusion, ECMO use has increased recently not only because of the overall increased use of ECMO in both non-pregnant and pregnant women1 but also due to the COVID-19 crisis which has led to a growing number of patients (pregnant or not) in whom ECMO was needed for survival 2…”

Section: Commentmentioning

confidence: 99%

“…Second, data from a single institution2 or prospective series2 also give additional information which cannot be obtained in national registries as details are not available with the same precision. For example, a recent small series of 5 pregnant women with COVID-19 infection described the precise cause for using ECMO, the term at which the technique was started, and the duration of use.…”

Section: Commentmentioning

confidence: 99%

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Predictors and Hospital Outcomes in Pregnant Patients Undergoing Extracorporeal Membrane Oxygenation: A Nationwide Study

Bosch

Chaudhry

Wicker

et al. 2023

Obstetric Anesthesia Digest

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cesarean delivery is associated with a reduction in body temperature. 7 Before this study, no association between continuous spinal labor analgesia and ERMF had been described, and this finding therefore raises an interesting question about whether ERMF is in fact a misnomer given that it may not be restricted to epidural analgesia per se.Seiler's findings that there is no difference in the incidence or ERMF in parturients undergoing continuous spinal analgesia compared to continuous epidural analgesia is consistent with the hypothesis that ERMF occurs as a result of the neuraxial block's effects on thermoregulation during labor. Further, the reduced consumption of bupivacaine in the spinal analgesia group suggests that the hyperthermic response is unlikely to be dose dependent. Regardless of the true mechanism, we now know that maternal fever occurs just as frequently with continuous spinal analgesia as with epidural analgesia. As a common and potentially deleterious side effect of neuraxial labor analgesia (as well as a differential for maternal sepsis), we advocate for heightened awareness of this phenomenon among laboring patients and all those who treat them.

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“…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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Challenges and pitfalls of extracorporeal membrane oxygenation in critically-ill pregnant and peripartum women with COVID-19: a retrospective case series

Cited by 7 publications

References 20 publications

Extracorporeal Membrane Oxygenation in Pregnant and Postpartum Women With Critical Coronavirus Disease 2019 (COVID-19) Acute Respiratory Distress Syndrome

Extracorporeal Membrane Oxygenation in Pregnant and Postpartum Women With Critical Coronavirus Disease 2019 (COVID-19) Acute Respiratory Distress Syndrome

Predictors and Hospital Outcomes in Pregnant Patients Undergoing Extracorporeal Membrane Oxygenation: A Nationwide Study

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

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