Extracorporeal Membrane Oxygenation for Pregnant and Early Postpartum Women With Acute Respiratory Distress Syndrome Caused by Viral Pneumonia

Pneumonia is a common nonobstetric cause of acute respiratory distress syndrome (ARDS) and is the leading cause of intensive care unit admission in pregnant women. Acute respiratory distress syndrome is the most frequent indication for venovenous extracorporeal membrane oxygenation (VV ECMO) during pregnancy, with viral pneumonia as the primary etiology. The objective of this study was to review the maternal and fetal outcomes of pregnant and postpartum women with severe ARDS who were supported with VV ECMO. This retrospective observational study was conducted at a single ECMO center from December 2015 to March 2023. Eighteen pregnant and postpartum women who were supported with VV ECMO due to severe ARDS caused by viral pneumonia were included. The maternal and fetal survival rates were 83% and 61%. Major bleeding was a common complication for patients while on ECMO (38%). All maternal deaths were due to major bleeding. For pre-ECMO respiratory support, the mechanical ventilation (MV) duration ranged from 0 to 6 days, and the total MV duration ranged from 5 to 86 days. Survival rate among pregnant/early postpartum women who were placed on VV ECMO for respiratory support was not different from nonpregnant women. Bleeding remains a major complication that is associated with maternal and fetal mortality.