Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2022 Oct 17;26(1):312.
doi: 10.1186/s13054-022-04189-5.

Delivery decision in pregnant women rescued by ECMO for severe ARDS: a retrospective multicenter cohort study

Sarah Aissi James  1 , Christophe Guervilly  2 , Mathieu Lesouhaitier  3 , Alexandre Coppens  1 , Clément Haddadi  4 , Guillaume Lebreton  5   6 , Jacky Nizard  7 , Nicolas Brechot  1   5 , Benjamin Assouline  1 , Ouriel Saura  1 , David Levy  1 , Lucie Lefèvre  1 , Pétra Barhoum  1 , Juliette Chommeloux  1   5 , Guillaume Hékimian  1   5 , Charles-Edouard Luyt  1   5 , Antoine Kimmoun  4 , Alain Combes  1   5   8 , Matthieu Schmidt  9   10   11   12
Affiliations
Multicenter Study

Delivery decision in pregnant women rescued by ECMO for severe ARDS: a retrospective multicenter cohort study

Sarah Aissi James et al. Crit Care. .

Abstract

Background: Although rarely addressed in the literature, a key question in the care of critically pregnant women with severe acute respiratory distress syndrome (ARDS), especially at the time of extracorporeal membrane oxygenation (ECMO) decision, is whether delivery might substantially improve the mother's and child's conditions. This multicenter, retrospective cohort aims to report maternal and fetal short- and long-term outcomes of pregnant women with ECMO-rescued severe ARDS according to the timing of the delivery decision taken before or after ECMO cannulation.

Methods: We included critically ill women with ongoing pregnancy or within 15 days after a maternal/child-rescue-aimed delivery supported by ECMO for a severe ARDS between October 2009 and August 2021 in four ECMO centers. Clinical characteristics, critical care management, complications, and hospital discharge status for both mothers and children were collected. Long-term outcomes and premature birth complications were assessed.

Results: Among 563 women on venovenous ECMO during the study period, 11 were cannulated during an ongoing pregnancy at a median (range) of 25 (21-29) gestational weeks, and 13 after an emergency delivery performed at 32 (17-39) weeks of gestation. Pre-ECMO PaO2/FiO2 ratio was 57 (26-98) and did not differ between the two groups. Patients on ECMO after delivery reported more major bleeding (46 vs. 18%, p = 0.05) than those with ongoing pregnancy. Overall, the maternal hospital survival was 88%, which was not different between the two groups. Four (36%) of pregnant women had a spontaneous expulsion on ECMO, and fetal survival was higher when ECMO was set after delivery (92% vs. 55%, p = 0.03). Among newborns alive, no severe preterm morbidity or long-term sequelae were reported.

Conclusion: Continuation of the pregnancy on ECMO support carries a significant risk of fetal death while improving prematurity-related morbidity in alive newborns with no difference in maternal outcomes. Decisions regarding timing, place, and mode of delivery should be taken and regularly (re)assess by a multidisciplinary team in experienced ECMO centers.

Keywords: Acute respiratory distress syndrome; Delivery; Extracorporeal membrane oxygenation; Outcomes; Pregnant women.

PubMed Disclaimer

Conflict of interest statement

Pr Combes reports grants from Getinge, and personal fees from Getinge, Baxter, and Xenios outside the submitted work. Pr Schmidt reports receiving personal fees from Getinge, Drager, and Xenios, outside the submitted work. Pr Kimmoun reports receiving personal fees from Aguettant outside the submitted work. Dr Guervilly reported personal consulting fees from Xenios outside the submitted work. No other disclosures were reported.

Figures

Fig. 1
Fig. 1
Main in-ICU complications in critically ill pregnant or peripartum women with severe ARDS supported by ECMO according to the timing of delivery. ARDS, Acute respiratory distress syndrome; ECMO, extracorporeal membrane oxygenation; ICU, intensive care unit; VAP, ventilator-associated pneumonia
Fig. 2
Fig. 2
Childbirth survival A and birth terms B in critically ill pregnant or peripartum women with severe ARDS supported by ECMO according to the timing of delivery. ARDS, Acute respiratory distress syndrome; ECMO, extracorporeal membrane oxygenation; ICU, intensive care unit
See this image and copyright information in PMC

References

    1. Lapinsky SE. Acute respiratory failure in pregnancy. Obstet Med. 2015;8:126–132. doi: 10.1177/1753495X15589223. - DOI - PMC - PubMed
    1. Rush B, Martinka P, Kilb B, McDermid RC, Boyd JH, Celi LA. Acute respiratory distress syndrome in pregnant women. Obstet Gynecol. 2017;129:530–535. doi: 10.1097/AOG.0000000000001907. - DOI - PMC - PubMed
    1. Moore SA, Dietl CA, Coleman DM. Extracorporeal life support during pregnancy. J Thorac Cardiovasc Surg. 2016;151:1154–1160. doi: 10.1016/j.jtcvs.2015.12.027. - DOI - PubMed
    1. Daily WH, Katz AR, Tonnesen A, Allen SJ. Beneficial effect of delivery in a patient with adult respiratory distress syndrome. Anesthesiology. 1990;72:383–385. doi: 10.1097/00000542-199002000-00027. - DOI - PubMed
    1. da Fonseca EB, Damião R, Moreira DA. Preterm birth prevention. Best Pract Res Clin Obstet Gynaecol. 2020;69:40–49. doi: 10.1016/j.bpobgyn.2020.09.003. - DOI - PubMed

Publication types

LinkOut - more resources