Introduction: Severe Acute Respiratory Distress Syndrome (ARDS) in the third trimester of pregnancy is a rare, high-mortality event. Venovenous Extracorporeal Membrane Oxygenation (VV ECMO) is a critical salvage therapy, but data on the long-term health of the mother and child are extremely limited. We present a case with three-year follow-up to provide vital information on the long-term sequelae of this complex intervention. Case Presentation: A 26-year-old primigravida, and a known case of bronchial asthma, presented at 30 weeks gestation with acute respiratory failure secondary to severe community-acquired pneumonia. Despite maximal conventional lung-protective ventilation, her oxygenation remained refractory (P/F ratio <60). VV ECMO was initiated for gas exchange support. The mother was successfully weaned from ECMO on day 7. An urgent Cesarean section was performed 5 days later, delivering a preterm female neonate (Apgars 1/4, birth weight 1.2 kilogram). She was successfully discharged on hospital day 39. Outcomes and Follow-up: At 3-year follow-up, both mother and child exhibited remarkably favorable outcomes. The mother reported no respiratory symptoms. She has a good Health‑Related Quality Of Life Index (EQ‑5D). The child met all developmental milestones at the 3-year assessment according to the Bayley Scales of Infant and Toddler Development, Fourth Edition (Bayley-4). Conclusion: This case report demonstrates that VV ECMO for severe ARDS pneumonia in the second trimester can lead to excellent long-term outcomes for both the mother and the surviving child. Successful outcomes depend on prompt cannulation at a specialized center, a multidisciplinary team approach, and optimized timing of delivery. This three-year follow-up provides a rare, reassuring data point to guide clinical decision-making and parental counseling for this high-risk population, emphasizing the potential for complete recovery. Reference: Ramanathan, K., et al. Extracorporeal Membrane Oxygenation in Pregnancy: An Analysis of the Extracorporeal Life Support Organization Registry. Crit Care Med. 2020.
Pillai et al. (Sun,) studied this question.