Perinatal outcomes of pregnant women with severe COVID-19 requiring extracorporeal membrane oxygenation (ECMO): a case series and literature review

Abstract

Purpose Pregnant women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have a higher risk of hospitalization, admission to intensive care unit (ICU) and invasive ventilation, and of acute respiratory distress syndrome (ARDS). In case of ARDS and critical severe coronavirus disease 2019 (COVID-19), the use of extracorporeal membrane oxygenation (ECMO) is recommended when other respiratory support strategies (oxygen insufflation, non-invasive ventilation [NIV], invasive ventilation through an endotracheal tube) are insufficient. However, available data on ECMO in pregnant and postpartum women with critical COVID-19 are very limited. Methods A case series of three critically ill pregnant women who required ECMO support for COVID-19 in pregnancy and/or in the postpartum period. Results The first patient tested positive for COVID-19 during the second trimester, she developed ARDS and required ECMO for 38 days. She was discharged in good general conditions and a cesarean-section [CS] at term was performed for obstetric indication. The second patient developed COVID-19-related ARDS at 28 weeks of gestation. During ECMO, she experienced a precipitous vaginal delivery at 31 weeks and 6 days of gestation. She was discharged 1 month later in good general conditions. The third patient, an obese 43-year-old woman, tested positive at 38 weeks and 2 days of gestation. Because of the worsening of clinical condition, a CS was performed, and she underwent ECMO. 143 days after the CS, she died because of sepsis and multiple organ failure (MOF). Thrombosis, hemorrhage and infections were the main complications among our patients. Neonatal outcomes have been positive. Conclusion ECMO should be considered a life-saving therapy for pregnant women with severe COVID-19.

Pregnancy-Associated Extracorporeal Membrane Oxygenation in the United States

“…It is highly likely forthcoming data from the period 2020 to present (including cases associated with the COVID-19 pandemic) will demonstrate a marked increase in use of ECMO in pregnancy, further elucidating maternal outcomes. 15 In addition, several centers are actively linking maternal and neonatal records for data collection, which should allow for improved study of the relationship of maternal ECMO to neonatal outcomes.…”

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

“…Two case reports have described successful ECMO management, 13 , 14 and a case series of three patients from Italy has demonstrated maternal survival of 67%. 15 …”

“…Two case reports have described successful ECMO management, 13,14 and a case series of three patients from Italy has demonstrated maternal survival of 67%. 15 Recently, Barrantes et al 16 presented a case series of nine pregnant or peripartum women with COVID-19 ARDS managed with V-V ECMO. The results of this study are interesting because they are, on the one hand very comparable to our study, but also demonstrate significant differences.…”

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

“…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].…”