Nada Mohamed, MD
West Virginia University
Morgantown, West Virginia
Disclosure information not submitted.
Amber Ganoe
ECMO specialist
West Virginia University, United States
Disclosure information not submitted.
Jamie Stebler
Perfusionist
West Virginia University, United States
Disclosure information not submitted.
Jeremiah Hayanga, MD, MPH, MHL
Professor, Department of Cardiovascular & Thoracic Surgery; Director, WVU ECMO Program
West Virginia University Medicine, United States
Disclosure information not submitted.
Ankit Sakhuja, MBBS, FACP, FASN, FCCP
Assistant Professor Of Medicine
WVU Medicine, J.W. Ruby Memorial Hospital, United States
Disclosure information not submitted.
Title: Case report of a Pregnant COVID-19 patient requiring ECMO Support
Case Report Body:
Introduction: When compared with nonpregnant women, pregnant and postpartum women are at increased risk for severe illness requiring hospitalization, intensive care, and mechanical ventilation from respiratory viral illnesses. Development of acute respiratory distress syndrome in these patients is a strong indicator for mortality. Pregnant and postpartum who experience critical cardiac or pulmonary illness may be treated with extracorporeal membrane oxygenation (ECMO) as salvage therapy when available. We present a case of a pregnant patient with ARDS secondary to COVID-19 who was selected for ECMO therapy.
Description: A 28 year old female G3P1 33 weeks gestation admitted to the medical intensive care unit for worsening respiratory failure related to COVID-19. The patient tested positive for COVID-19 7 days prior to admission. On day 2 of admission, the patient was intubated for worsening respiratory and signs of fetal distress on fetal heart tracings. The decision to pursue an emergency cesarean section followed by EMCO cannulation was made. Both procedures were uneventful. Access site was the right femoral vein via 25 multistage catheter and the return site was the right internal jugular vein via a 20 french catheter. Unfractionated heparin and CytoSorb therapy were initiated at the time of cannulation. The patient did well and was decannulated from ECMO on day 8 of admission. On day 10 of admission the patient once again decompensated requiring reintubation and was placed back on ECMO with another run of CytoSorb. The access site was the right internal jugular vein via 28 french Crescent catheter. Unfractionated heparin was re-initiated for anticoagulation and transitioned to bivalirudin on day 3 of ECMO. She remained on ECMO until day 32 of admission when she was once again decannulated. The patient was discharged home after a 38 day hospital stay. Her baby boy was home awaiting her arrival.
Discussion: Pregnant patients who contract viral illnesses such as COVID-19 can suffer dire consequences. VV ECMO can serve as salvage therapy for such patients after all other avenues have failed. Our patient required cannulation for ECMO with CytoSorb therapy two times during hospitalization, but ultimately recovered with minimal physical impairments following hospitalization.