Key result
Awake VA-ECMO enables successful delivery and dual survival in severe pregnancy-associated pulmonary hypertension.
Why the study?
Management strategies for severe treatment naïve pulmonary hypertension in pregnancy, including the use of awake venoarterial ECMO as a bridge to foetal maturation, require detailed clinical illustration.
Can awake venoarterial ECMO serve as a bridge to foetal maturation in a pregnant patient with severe pulmonary hypertension?
Case Report (n=1)
Can awake venoarterial ECMO serve as a bridge to foetal maturation in a pregnant patient with severe pulmonary hypertension?
Awake venoarterial ECMO may be successfully utilized as a bridge to foetal maturation in pregnant patients with severe pulmonary hypertension, though it requires intensive multidisciplinary management.
May support awake VA-ECMO in select pregnant PH patients declining termination; hypothesis-generating and should not yet change practice.
A 37-year-old patient (gravida 10, para 0-1-8-0) with class III obesity, obstructive sleep apnoea requiring continuous positive airway pressure and previous pulmonary emboli presented at 19 + 6 weeks' gestation with severe treatment naïve pulmonary hypertension. Termination of pregnancy was recommended but declined. Following multidisciplinary planning, awake peripheral venoarterial extracorporeal membrane oxygenation (ECMO) was initiated under local anaesthesia at 23 + 1 weeks to support further foetal maturation. At day 4 of ECMO support acute hypoxaemia necessitated intubation, conversion to venoarterial-venous ECMO and urgent classical caesarean delivery. A 550-g female was delivered and admitted to neonatal intensive care. Postpartum haemodynamic improvement permitted deescalation to venovenous ECMO. The patient was liberated from extracorporeal support after 17 days and despite both suffering morbidity, mother and infant have since returned home. This case illustrates complex obstetric management decisions and highlights the necessity of multidisciplinary engagement in navigating the nexus between maternal autonomy and resource-intensive care.
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Worku et al. (2026) conducted a case report in Severe pulmonary hypertension (n=1). Awake venoarterial extracorporeal membrane oxygenation (ECMO) was evaluated. Awake venoarterial ECMO served as a successful bridge to fetal maturation and delivery in a pregnant woman with severe pulmonary hypertension, with both mother and infant surviving.
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