Key result
ECMO carries ~36% maternal mortality in severe peripartum COVID-19, driven by neurological complications.
Why the study?
Pregnant women with severe COVID-19 pneumonia and refractory hypoxemic respiratory failure may require ECMO, but maternal-fetal risk factors, complications, and outcomes are not well described.
Observational (n=11)
ECMO is a viable alternative for pregnant women with severe COVID-19 hypoxemic respiratory failure, though neurological complications and early-pregnancy stillbirths remain significant risks.
ECMO in refractory COVID-19 pregnancy yielded 36% maternal mortality, mostly neurological; leaves open optimal timing, protocols, and fetal risk stratification for prospective study.
OBJECTIVE: COVID-19 infection may produce severe pneumonia, mainly in the adult population. Pregnant women with severe pneumonia are at high risk of developing complications, and conventional therapy sometimes fails to reverse hypoxemia. Therefore, extracorporeal membrane oxygenation (ECMO) is an option in cases with refractory hypoxemic respiratory failure. This study aims to evaluate the maternal-fetal risk factors, clinical characteristics, complications, and outcomes of 11 pregnant or peripartum patients with COVID-19 treated with ECMO. STUDY DESIGN: This is a retrospective descriptive study of 11 pregnant women undergoing ECMO therapy during the COVID-19 pandemic. RESULTS: In our cohort, four patients underwent ECMO during pregnancy (36.3%) and 7 during the postpartum period. Initially, they started on venovenous ECMO, and three patients were required to change modality due to clinical conditions. In total, 4/11 pregnant women (36.3%) died. We established two periods that differed in the implementation of a standardized care model for reducing associated morbidities and mortality. Neurological complications were responsible for most deaths. Regarding fetal outcomes at early-stage pregnancies on ECMO (4), we report three stillbirths (75%), and one newborn (twin pregnancy) survived and had a favorable evolution. CONCLUSION: At later-stage pregnancies, all newborns survived, and we did not identify any vertical infection. ECMO therapy is an alternative for pregnant women with severe hypoxemic respiratory failure due to COVID-19, and may improve maternal and neonatal results. Regarding fetal outcomes, the gestational age played a definitive role. However, the main complications reported in our series and others are neurological. It is essential to develop novel, future interventions to prevent these complications.
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Alvarado-Socarrás et al. (2023) conducted an observational in COVID-19 with severe hypoxemic respiratory failure (n=11). Extracorporeal membrane oxygenation (ECMO) was evaluated on Maternal mortality. Among 11 pregnant or peripartum women with COVID-19 treated with ECMO, maternal mortality was 36.3% (4/11), with neurological complications being the primary cause of death.