Shikha Kapil, MD
Assistant Professor/Attending Physician
MedStar Washington Hospital Center/Georgetown University SOM
Washington, District of Columbia, United States
Disclosure information not submitted.
Jeffrey Cohen, MD
Attending Physician
MedStar Washington Hospital Center, United States
Disclosure information not submitted.
Mohammed Nabeel, MD
Attending Physician
MedStar Washington Hospital Center, United States
Disclosure information not submitted.
Brian Lee, MPH, PhD
Research Assistant Professor of Pediatrics
Children's Mercy Hospital, United States
Disclosure information not submitted.
Title: Successful Delivery of a COVID-19 Positive Pregnant Woman While Supported by VV ECMO
Case Report Body:
Introduction: Severe Sars-CoV-2 (COVID-19) infection has been reported in both pregnant and postpartum women despite young age and lack of comorbidities. Extracorporeal membrane oxygenation (ECMO) for refractory hypoxemic respiratory failure has been effective in managing COVID-19 related ARDS. While there are no randomized clinical trials demonstrating improved outcomes in peripartum women, current literature supports the use of ECMO in both pregnant and postpartum patients with severe COVID-19 infection. There is also a paucity of data regarding specific indications for preterm delivery in pregnant patients with severe COVID-19 infection, as well as the safety and feasibility of performing a cesarean section on a patient receiving ECMO, particularly at a gestational age less than 27 weeks.
Description: We present a case of a 36-year-old patient, G2P1001 at a gestational age of 26 weeks and 4 days with severe acute hypoxemic respiratory failure secondary to COVID-19 infection, requiring extracorporeal membrane oxygenation who underwent successful cesarean section while on ECMO. The patient presented at 25 weeks and 1 day with severe ARDS due to COVID-19. She was intubated 7 days after diagnosis of COVID-19 and was cannulated for VV ECMO within 24 hours of intubation. At gestational age of 26 weeks and 4 days, and day 10 of her ECMO run, tocometry demonstrated non-reassuring fetal heart tones. A multidisciplinary team consisting of an intensivist, cardiac surgeon, obstetrician, and neonatologist accompanied the patient to the operating room. She remained on VV ECMO support while undergoing a Cesarean section. The operation and delivery were uncomplicated. The neonate was intubated and taken to the NICU, with APGAR scores of 5 and 9.
The patient returned to the ICU, while still on VV ECMO in stable condition and anticoagulation was resumed. Her pulmonary function improved, and she was decannulated from VV ECMO after 41 days. The patient and neonate were both discharged from the hospital in stable condition.
Discussion: Pulmonary recovery in COVID-19 related ARDS is often prolonged. Despite concerns surrounding coagulopathy, anticoagulation, and physiology specific to pregnant patients, this case demonstrates successful surgical intervention is possible while remaining on VV ECMO support.