The following is a summary of “Delivery decision in pregnant women rescued by ECMO for severe ARDS: a retrospective multicenter cohort study” published in the October 2022 issue of Critical Care by James, et al.
Even though it’s rarely talked about in the literature, one of the most important things to think about when caring for critically pregnant women with severe acute respiratory distress syndrome (ARDS), especially when deciding whether or not to use extracorporeal membrane oxygenation (ECMO), is whether or not giving birth could greatly improve the health of both the mother and the baby. This retrospective, multicenter cohort study aims to find out how pregnant women with severe ARDS who were saved by ECMO did in the short and long term, depending on when the decision to deliver was made, before or after ECMO cannulation. Researchers looked at critically ill women who were pregnant or had just given birth within 15 days of being helped by ECMO for severe ARDS in four ECMO centers between October 2009 and August 2021.
Both the mother’s and the child’s clinical characteristics, critical care management, complications, and hospital discharge status were taken into account. The long-term effects and complications of having a baby early were looked at. During the study period, 563 women were on continuous ECMO. Of these, 11 were cannulated while still pregnant at a median (range) gestational week of 25 (21–29) and 13 were cannulated after an emergency delivery at a gestational week of 32 (17–39). Before ECMO, the ratio of PaO2/FiO2 was between 57 and 98, and there was no difference between the 2 groups. Patients who were on ECMO after giving birth were more likely to have major bleeding (46 vs. 18%, P=0.05) than those who were still pregnant. Overall, 88% of moms who went to the hospital lived, which was the same for both groups.
On ECMO, 4 pregnant women gave birth on their own. When ECMO was set up after delivery, the fetal survival rate was higher (92% vs. 55%, P=0.03). No severe preterm morbidity or long-term effects were reported in babies who were born alive. If the pregnancy is kept going with the help of ECMO, there is a big chance that the baby will die, but the baby’s health will be better and the mother’s won’t change. In ECMO centers with a lot of experience, decisions about timing, place, and method of delivery should be made and regularly reevaluated by a team of experts from different fields.