Treatment of Acute Respiratory Distress Syndrome from COVID-19 with Extracorporeal Membrane Oxygenation in Obstetric Patients.

ABSTRACT Background Extracorporeal membrane oxygenation therapy (ECMO) has been used as a rescue therapy for patients with severe acute respiratory distress syndrome (ARDS) from COVID-19 who have failed conventional ventilatory strategies. Little is known about the outcome of pregnant and postpartum patients on ECMO. Objectives Describe the medical and surgical outcomes of pregnant and postpartum patients who were placed on ECMO therapy for severe ARDS from COVID-19. Study Design A case series reviewing pregnant or post-partum patients with laboratory confirmed COVID-19 who were placed on ECMO was conducted within the Baylor Scott & White Healthcare system. Demographics, medical, and surgical outcomes were collected and reviewed. Results Between March 2020 and October 2021, 5 pregnant and 5 postpartum women were supported with veno-venous ECMO. Median age was 30 (IQR 26-33.5) years and median BMI was 36.6 (IQR 29.5-42.0) kg/m2. There was a median of 4.5 (IQR 1.5-6.8) days from admission to any hospital to intubation and 9 (IQR 7-13) days to ECMO cannulation. One patient had an ischemic stroke, one patient had presumed hemorrhagic stroke, and nine patients developed bleeding while on ECMO. Of the five pregnant women, two patients had intrauterine fetal demise and three underwent delivery for maternal hemodynamic instability. The five postpartum women were initiated on ECMO a median of 10 (IQR 3-11) days after delivery. The median length of time on ECMO was 22 (IQR 11-31) days. At the time of the study there were two inpatient mortalities, six patients who survived to discharge to from the ECMO hospital, and two patients still admitted. Conclusions There is limited information regarding the use of ECMO for COVID-19 ARDS in obstetric patients. This case series describes use of ECMO and survival in pregnant and post-partum patients with COVID-19.