Nazih Zuhdi Transplant Institute, Advanced Cardiac and Critical Care, 24/7 Shock & ECMO Service, Integris Health, Oklahoma City, OK, USA.
The Perinatal Center, Maternal Fetal Medicine, Oklahoma City, OK, USA.
Int J Artif Organs. 2023 May;46(5):289-294. doi: 10.1177/03913988231168431. Epub 2023 Apr 12.
Extracorporeal membrane oxygenation (ECMO) is an intervention used for patients with acute respiratory distress syndrome (ARDS) from COVID-19 who have failed conventional ventilatory strategies. Very few studies have given insight into the outcomes of pregnant and postpartum patients requiring ECMO support.
Single center, retrospective, observational study of female pregnant and postpartum patients suffering COVID-19 ARDS and requiring ECMO.
Eight SARS-CoV-2 positive patients were identified. The average age was 31 ± 4 years, with Body Mass Indices (BMI) and SOFA scores ranging between 32-49 and 8-11, respectively. Two patients were pregnant at the time of ECMO initiation, two were peripartum, and four were postpartum. Five patients (63%) had bleeding, and one patient had a hysterectomy. Seven patients (88%) were supported by V-V ECMO and one with V-A ECMO. Patients had between one and three circuit exchanges due to oxygenator failure or clots in the circuit. All patients were in ICU between 7 and 74 days, with hospital length of stay between 8 and 81 days. All patients were weaned off ECMO and were successfully discharged from the hospital. All newborns were born via cesarean section, and all survived to discharge.
Our study shows a 100% neonatal and maternal survival rate demonstrating that ECMO in this patient population is safe. These patients should be transferred to experienced high-volume ECMO centers with the ability to perform emergent cesarean sections. ECMO should be considered a life-saving therapy for pregnant women with severe COVID-19 with an overall excellent maternal and neonatal survival rate.
体外膜肺氧合（ECMO）是一种用于治疗 COVID-19 引起的急性呼吸窘迫综合征（ARDS）且常规通气策略失败的患者的干预措施。很少有研究深入了解需要 ECMO 支持的妊娠和产后患者的结局。
对患有 COVID-19 ARDS 且需要 ECMO 支持的女性妊娠和产后患者进行单中心回顾性观察性研究。
确定了 8 例 SARS-CoV-2 阳性患者。平均年龄为 31±4 岁，体重指数（BMI）和 SOFA 评分分别在 32-49 和 8-11 之间。2 名患者在 ECMO 启动时怀孕，2 名患者处于围产期，4 名患者产后。5 名患者（63%）有出血，1 名患者行子宫切除术。7 名患者（88%）接受 V-V ECMO 支持，1 名患者接受 V-A ECMO 支持。由于氧合器故障或回路中有血栓，患者需要进行 1 到 3 次回路更换。所有患者均在 ICU 接受治疗 7 至 74 天，住院时间为 8 至 81 天。所有患者均成功撤机并出院。所有新生儿均通过剖宫产分娩，均存活至出院。
我们的研究表明，新生儿和产妇的存活率为 100%，表明 ECMO 在该患者人群中是安全的。这些患者应转至具有进行紧急剖宫产能力的经验丰富的大容量 ECMO 中心。对于患有严重 COVID-19 的孕妇，ECMO 应被视为一种救命疗法，总体上具有极好的母婴存活率。
