Extracorporeal Membrane Oxygenation in Pregnant Women With COVID-19

Abstract

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and lung involvement is common. Patients with COVID-19 may progress to acute respiratory distress syndrome (ARDS) for which they may require mechanical ventilation. When conventional ventilation strategies are unable to achieve the desired oxygenation and gas exchange, extracorporeal membrane oxygenation (ECMO) might be an option in selected patients. The literature on the use of ECMO in peripartum women with COVID-19 is limited. We present a series of ten cases involving pregnant and recently pregnant women who rapidly developed ARDS after the onset of COVID-19 for which they received ECMO. Nine of the 10 patients survived intensive care unit discharge after a gradual recovery of their pulmonary function and weaning from mechanical ventilation and ECMO. In addition, 9 out of the 10 delivered neonates survived neonatal intensive care unit discharge.

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

“…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.…”

“…In total, 21 studies with 386 pregnant individuals who had critical COVID-19 managed with ECMO were included in the review. 4,6,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] Study characteristics and results were summarized and verified for accuracy independently by two authors. Features of the included studies are shown in Table 1.…”

Extracorporeal life support in pregnant and postpartum women with COVID-19-related acute respiratory distress syndrome

“…In another report from a group in Kuwait, Mohammed Bamasood et al 17 report on 10 peripartum patients who required ECMO (two V-VA, eight V-V). Five out of 10 patients were postpartum and the other five were still pregnant.…”

Extra corporeal membrane oxygenation (ECMO) in pregnant and postpartum women

“…Use of ECMO in pregnancy has been well documented 1,2 and, although the need for ECMO remains a rare complication of pregnancy and the puerperium, the COVID-19 pandemic led to increased utilisation and awareness in pregnant or recently pregnant women and people. [3][4][5] Local data highlight that pregnant and postpartum women represented 25% of the aged 18-49 female cohort receiving ECMO during the COVID-19 pandemic. 6 A similar increase in use of ECMO in this population was noted during the H1N1 influenza pandemic in 2009.…”

“…ECMO is not without risk, and patient selection is dependent on the perceived reversibility of the underlying pathology and factors that predict outcome, including severity of current illness and need for other organ support, pre‐existing co‐morbidities and rehabilitation potential. Use of ECMO in pregnancy has been well documented 1,2 and, although the need for ECMO remains a rare complication of pregnancy and the puerperium, the COVID‐19 pandemic led to increased utilisation and awareness in pregnant or recently pregnant women and people 3‐5 . Local data highlight that pregnant and postpartum women represented 25% of the aged 18–49 female cohort receiving ECMO during the COVID‐19 pandemic 6 .…”