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Treatment of acute respiratory distress syndrome from COVID-19 with extracorporeal membrane oxygenation in obstetrical patients.
Shih, Emily; DiMaio, J Michael; Squiers, John J; Krueger, Anita R; Schwartz, Gary S; Herd, James; Bleich, April T.
  • Shih E; Department of General Surgery, Baylor University Medical Center, Baylor Scott & White Health, Dallas, TX (Drs Shih and Squiers). Electronic address: emily.shih@bswhealth.org.
  • DiMaio JM; Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital - Plano, Baylor Scott & White Health, Plano, TX (Dr DiMaio).
  • Squiers JJ; Department of General Surgery, Baylor University Medical Center, Baylor Scott & White Health, Dallas, TX (Drs Shih and Squiers).
  • Krueger AR; Department of Cardiothoracic Surgery, Baylor Scott and White All Saints Medical Center, Baylor Scott & White Health, Fort Worth, TX (Dr Krueger).
  • Schwartz GS; Department of Cardiothoracic Surgery, Baylor University Medical Center, Baylor Scott & White Health, Dallas, TX (Dr Schwartz).
  • Herd J; Department of Obstetrics and Gynecology, Baylor Scott and White All Saints Medical Center,Baylor Scott & White Health, Fort Worth, TX (Drs Herd and Bleich).
  • Bleich AT; Department of Obstetrics and Gynecology, Baylor Scott and White All Saints Medical Center,Baylor Scott & White Health, Fort Worth, TX (Drs Herd and Bleich).
Am J Obstet Gynecol MFM ; 4(2): 100537, 2022 03.
Article in English | MEDLINE | ID: covidwho-1598047
ABSTRACT

BACKGROUND:

Extracorporeal membrane oxygenation therapy has been used as a rescue therapy for patients with severe acute respiratory distress syndrome from COVID-19 who have failed conventional ventilatory strategies. Little is known about the outcome of pregnant and postpartum patients on extracorporeal membrane oxygenation therapy.

OBJECTIVE:

To describe the medical and surgical outcomes of pregnant and postpartum patients who were placed on extracorporeal membrane oxygenation therapy for severe acute respiratory distress syndrome from COVID-19. STUDY

DESIGN:

A case series reviewing pregnant or postpartum patients with laboratory-confirmed COVID-19 who were placed on extracorporeal membrane oxygenation therapy was conducted within the Baylor Scott & White Healthcare system. The demographics and the medical and surgical outcomes were collected and reviewed.

RESULTS:

Between March 2020 and October 2021, 5 pregnant and 5 postpartum women were supported with venovenous extracorporeal membrane oxygenation therapy. The median age was 30 years (interquartile range, 26-33.5) and the median body mass index was 36.6 kg/m2 (interquartile range, 29.5-42.0). There was a median of 4.5 days (interquartile range, 1.5-6.8) from admission to any hospital to intubation and 9 days (interquartile range, 7-13) to extracorporeal membrane oxygenation therapy cannulation. One patient had an ischemic stroke, 1 patient had a presumed hemorrhagic stroke, and 9 patients developed bleeding while on extracorporeal membrane oxygenation therapy. Of the 5 pregnant women, 2 patients had intrauterine fetal demise and 3 underwent delivery for maternal hemodynamic instability. The 5 postpartum women were initiated on extracorporeal membrane oxygenation therapy a median of 10 days (interquartile range, 3-11) after delivery. The median length of time on extracorporeal membrane oxygenation therapy was 22 days (interquartile range, 11-31). At the time of the study, there were 2 inpatient mortalities, 6 patients survived to discharge from the extracorporeal membrane oxygenation therapy hospital, and 2 patients were still admitted.

CONCLUSION:

There is limited information regarding the use of extracorporeal membrane oxygenation therapy for COVID-19 acute respiratory distress syndrome in obstetrical patients. This case series describes the use of extracorporeal membrane oxygenation therapy and survival in pregnant and postpartum patients with COVID-19.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / Extracorporeal Membrane Oxygenation / COVID-19 Type of study: Diagnostic study / Observational study / Prognostic study Topics: Long Covid Limits: Adult / Female / Humans / Pregnancy Language: English Journal: Am J Obstet Gynecol MFM Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / Extracorporeal Membrane Oxygenation / COVID-19 Type of study: Diagnostic study / Observational study / Prognostic study Topics: Long Covid Limits: Adult / Female / Humans / Pregnancy Language: English Journal: Am J Obstet Gynecol MFM Year: 2022 Document Type: Article