The successful use of extra-corporeal membrane oxygenation in the management of a pregnant woman with severe H1N1 2009 influenza complicated by pneumonitis and adult respiratory distress syndrome

Abstract

We report a case of H1N1 2009 influenza A, in a previously fit woman at 24 weeks of gestation, who presented atypically with abdominal pain. The infection was complicated by severe respiratory failure and acute respiratory distress syndrome, requiring ventilatory support, including extra-corporeal membrane oxygenation (ECMO). This was one of the first cases of severe H1N1 disease presenting in the UK. Use of extra-corporeal membrane oxygenation for the complications of H1N1 resulted in full maternal recovery and subsequent delivery of a healthy infant.

Extracorporeal Membrane Oxygenation in Pregnancy

“…Cases characterized by more severe clinical manifestations seem more likely to present during the third trimester of gestation, as in our patient . The majority of single case reports describe ECMO as a rescue therapy in ARDS during pregnancy due to A/H1N1 influenza; no instances of fatal maternal outcome are reported in these isolated cases . ARDS requiring ECMO during pregnancy has also been attributed to other less common etiologies, such as staphylococcal septicemia, chickenpox pneumonia or spontaneous intrapulmonary hemorrhage; ARDS of unknown etiology during pregnancy has also been treated by ECMO .…”

Maternal and fetal recovery after severe respiratory failure due to influenza: a case report

“…Successful maternal outcome after ECMO treatment for severe respiratory failure/acute respiratory distress in pregnancy was reported in small series [8-10,24-26]. It has been necessary to administer systemic anticoagulation to enable ECMO treatment; hence hemorrhagic complications have been common with reported rates of 54% among pregnant and non-pregnant patients [8].…”

Use of Extracorporeal Respiratory Support During Pregnancy

“…9 In addition, some successful single cases have been reported. [10][11][12] The main technical problem expected with ECMO in pregnancy is difficult blood drainage because of caval compression by the gravid uterus: emergency delivery or placement of additional venous cannulas may be required. 13 In our patient a femorojugular bypass was used, blood was drained through a femoral cannula of very large caliber (25 F), and the patient was kept in left lateral decubitus: this allowed the maintenance of a high extracorporeal blood flow without excessive negative suction pressures.…”