Young Investigator Award Presentations: Winner
Peripartum ECMO for COVID-19
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Our center has supported 43 patients with COVID-19 ARDS on ECMO. Of these, 8 cases (19%) were in peripartum women, and their rate of survival was 86%. Notable points regarding the pregnant cohort (4 patients) include the fact that all neonates born on ECMO were preterm and required intubation but ultimately survived. Of interest in the postpartum cohort (4 patients) is the fact that 3 of them suffered clinical decompensation on post-partum days 1-2, suggesting a common physiologic mechanism, such as the autotransfusion following delivery. The only mortality in our cohort occurred in a postpartum woman secondary to anoxic brain injury from a pre-ECMO hypoxic cardiac arrest. The main learning from our experience is that ECMO provides a relatively safe and effective way to enhance maternal oxygenation and ventilation for the developing fetus while maintaining lung protective ventilation. Pregnancy is not an absolute contraindication to proning, but it may not be tolerated in all patients. ECMO allowed us to achieve a higher SpO2 goal of >92% for fetal oxygen delivery, and normocapnia to balance fetal CO2 clearance and placental perfusion. We experienced challenges with device flow due to caval compression and contractions that were responsive to fluid resuscitation and left lateral positioning. We learned that preterm delivery has not been proven to improve maternal oxygenation in ARDS and thus planned for delivery in the OR only for fetal indications, or bedside cesarean for maternal arrest. Steroids provided dual benefit in COVID-19 pneumonia and fetal lung maturity. These experiences at our center highlighted the ability of ECMO to enhance peripartum supportive care in COVID-19, and the importance of multidisciplinary teamwork and careful patient selection.