Key result
Continuation of pregnancy on ECMO support for severe ARDS was associated with lower fetal survival compared to ECMO cannulation after delivery (55% vs 92%, p=0.03), with no difference in maternal survival.
Why the study?
It was unclear whether delivery improves maternal and fetal conditions in critically pregnant women with severe ARDS at the time of deciding on ECMO rescue.
Does the timing of delivery (before vs. after ECMO cannulation) affect maternal and fetal outcomes in pregnant women with severe ARDS requiring ECMO?
Cohort (n=24)
Yes
Does the timing of delivery (before vs. after ECMO cannulation) affect maternal and fetal outcomes in pregnant women with severe ARDS requiring ECMO?
Absolute Event Rate: 55% vs 92%
p-value: p=0.03
In pregnant women with severe ARDS requiring ECMO, delivery prior to ECMO cannulation improves fetal survival without compromising maternal survival, though it may increase the risk of major bleeding.
Delivery timing in ECMO-rescued ARDS pregnancy warrants multidisciplinary reassessment; retrospective data leaves open optimal strategy for maternal-fetal survival.
BACKGROUND: Although rarely addressed in the literature, a key question in the care of critically pregnant women with severe acute respiratory distress syndrome (ARDS), especially at the time of extracorporeal membrane oxygenation (ECMO) decision, is whether delivery might substantially improve the mother's and child's conditions. This multicenter, retrospective cohort aims to report maternal and fetal short- and long-term outcomes of pregnant women with ECMO-rescued severe ARDS according to the timing of the delivery decision taken before or after ECMO cannulation. METHODS: We included critically ill women with ongoing pregnancy or within 15 days after a maternal/child-rescue-aimed delivery supported by ECMO for a severe ARDS between October 2009 and August 2021 in four ECMO centers. Clinical characteristics, critical care management, complications, and hospital discharge status for both mothers and children were collected. Long-term outcomes and premature birth complications were assessed. RESULTS: ratio was 57 (26-98) and did not differ between the two groups. Patients on ECMO after delivery reported more major bleeding (46 vs. 18%, p = 0.05) than those with ongoing pregnancy. Overall, the maternal hospital survival was 88%, which was not different between the two groups. Four (36%) of pregnant women had a spontaneous expulsion on ECMO, and fetal survival was higher when ECMO was set after delivery (92% vs. 55%, p = 0.03). Among newborns alive, no severe preterm morbidity or long-term sequelae were reported. CONCLUSION: Continuation of the pregnancy on ECMO support carries a significant risk of fetal death while improving prematurity-related morbidity in alive newborns with no difference in maternal outcomes. Decisions regarding timing, place, and mode of delivery should be taken and regularly (re)assess by a multidisciplinary team in experienced ECMO centers.
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James et al. (2022) conducted a cohort in Severe acute respiratory distress syndrome (ARDS) (n=24). ECMO cannulation during ongoing pregnancy vs. ECMO cannulation after delivery was evaluated on Fetal survival (alive at birth) (p=0.03). Continuation of pregnancy on ECMO support for severe ARDS was associated with lower fetal survival compared to ECMO cannulation after delivery (55% vs 92%, p=0.03), with no difference in maternal survival.
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