Outcomes Following Extracorporeal Membrane Oxygenation for Severe COVID-19 in Pregnancy or Post Partum

• DOI: 10.1001/jamanetworkopen.2023.14678
• Publication Date: 2023-05-22T15:33:39Z
• Authors: John J. Byrne; Amir A. Shamshirsaz; Alison G. Cahill; Mark A. Turrentine; Angela R. Seasely; Joe Eid; Caroline E. Rouse; Michael Richley; Nandini Raghuraman; Mariam Naqvi; Yasser Y. El-Sayed; Martina L. Badell; CeCe Cheng; James Liu; Emily H. Adhikari; Soha S. Patel; Erika R. O’Neil; Patrick S. Ramsey
• Keywords: Adult; Medical Sciences; Bioinformatics; Epidemiology; 610; Biomedical Informatics; Cohort Studies; Extracorporeal Membrane Oxygenation; Pregnancy; Medical Specialties; Medicine and Health Sciences; Humans; Pregnancy Complications, Infectious; Original Investigation; Extracorporeal membrane oxygenation; SARS-CoV-2; Postpartum Period; Infectious; ICTS (Institute of Clinical and Translational Sciences); Infant, Newborn; Obstetrics and Gynecology; Infant; COVID-19; Postpartum period; Newborn; 3. Good health; Pregnancy Complications; Pregnancy complications; Women's Health; Female; Public Health; Respiratory Insufficiency

Importance Existing reports of pregnant patients with COVID-19 disease who require extracorporeal membrane oxygenation (ECMO) are limited, variable outcomes noted for the maternal-fetal dyad. Objective To examine maternal and perinatal associated ECMO used respiratory failure during pregnancy. Design, Setting, Participants This retrospective multicenter cohort study examined postpartum required at 25 hospitals across US. Eligible included individuals received care one sites, were diagnosed SARS-CoV-2 infection pregnancy or up to 6 weeks post partum by positive nucleic acid antigen test, whom was initiated from March 1, 2020, October 2022. Exposures in setting failure. Main outcome measures The primary mortality. Secondary serious morbidity, obstetrical outcomes, neonatal outcomes. Outcomes compared timing partum, initiation periods circulation variants. Results From 2022, 100 started on (29 [29.0%] Hispanic, [25.0%] non-Hispanic Black, 34 [34.0%] White; mean [SD] age: 31.1 [5.5] years), including 47 (47.0%) pregnancy, 21 (21.0%) within 24 hours 32 (32.0%) between partum; 79 (79.0%) had obesity, 61 (61.0%) public no insurance, 67 (67.0%) did not have an immunocompromising condition. median (IQR) run 20 (9-49) days. There 16 deaths (16.0%; 95% CI, 8.2%-23.8%) cohort, 76 (76.0%; 58.9%-93.1%) 1 more morbidity events. largest venous thromboembolism occurred 39 (39.0%), which similar (40.4% [19 47] vs 38.1% [8 21] immediately 37.5% [12 32]; P > .99). Conclusions Relevance In this US COVID-19–associated failure, most survived but experienced a high frequency morbidity.