Successful ECMO support in a pregnant severe ARDS patient due to Covid19 infection

Objective: Extracorporeal life support in pregnant severe ARDS patients was used during the H1N1 pandemic with good outcome. We report successful ECMO support in a pregnant patient with Covid19 infection. Methods: A 29-year old female G2P1 at 21 weeks of gestation presented to the emergency room in the tertiary referral center due to acute dyspnea, increased heart rate, cough, general malaise and fever reaching 39 °C. Three days after onset of the disease PGR test was performed and she was confirmed Covid19 positive. The laboratory tests showed elevated inflammatory markers (CRP 65 mg/l), leukopenia 5,4 x 109/l), chest X-ray revealed bilateral pneumonia. Patient also noted that fetal movements have decreased. Six miligrams of daily dexamethasone was administered along with nonspecific symtomatic treatment. Patients status deteriorated rapidly, respiratory failure progressed, and patient was intubated, mechanical ventilation (MV) was initiated. While on MV with fiO2 of 100% and PEEP cmH20 of 16 her paO2 remained 49 mmHg, paCO2 53 mmHg and saturation below 80%. With no further improvement femoro-jugular cannulation was performed and ECMO support was initiated. Following 48 ours on support she stillbirth 445 gr female fetus. No further active bleeding was registered. Results: After seven days of ECMO support she was gradually weaned and extubated few days later. Following 10 days ICU stay and uneventful recovery she was discharged from the hospital. Conclusions: Good clinical outcome can be achieved using ECMO support in critically ill pregnant patients with Covid19 infection.