Management of severe acute respiratory distress syndrome in a pregnant patient due to COVID-19 with ECMO

SARS-CoV-2 has become a devastating upper respiratory tract infection that may progress to severe acute respiratory distress syndrome (ARDS) which may cause long-term disability or even death. The severity of this disease has warranted intubation with ventilatory support, extracorporeal membrane oxygenation (ECMO), and lung transplantation in certain patient populations. Extracorporeal membrane oxygenation has been demonstrated and used as a treatment for severe ARDS due to COVID in various patient populations, with limited guidance in multiparous patients. This case report may be used as a guide to use ECMO in pregnant patients as patients of all demographics, including pregnant patients, are affected by COVID-19. Herein, we describe the management of a multiparous patient at 25 weeks gestational age who developed severe ARDS after COVID-19 infection, was subsequently taken to the operating room for cesarean section, and placed on ECMO with initial improvement in ventilation, oxygenation, and hemodynamics prior to transfer to a facility with capabilities to maintain patients on ECMO.