Extracorporeal Cardiopulmonary Resuscitation for Periviable Pregnancy With a Fetus In Situ

BACKGROUND: Maternal cardiac arrest at periviable gestation presents unique physiologic and logistical challenges. Evidence guiding the use of extracorporeal cardiopulmonary resuscitation (ECPR) in pregnancy remains limited, particularly relative to emergent cesarean delivery, a Class I guideline recommendation. CASE SUMMARY: A 32-year-old woman at 24 weeks and 5 days' gestation with newly diagnosed intrauterine fetal demise presented in refractory cardiogenic shock and suffered pulseless electrical activity arrest. Resuscitative hysterotomy was not feasible in the catheterization laboratory. Given absent return of spontaneous circulation and preexisting large-bore arterial access from an Impella, venoarterial extracorporeal membrane oxygenation was initiated for ECPR. After stabilization, the pregnancy was managed expectantly with coagulopathy monitoring. She was decannulated on hospital day 7, delivered spontaneously on day 11, and discharged home on day 60 with improved left ventricular function. TAKE-HOME MESSAGE: When rapid cannulation is feasible, ECPR may be lifesaving while maternal stabilization and individualized obstetric planning remain paramount.