PDF(Pubmed)
Abstract：
Available data identify pregnancy as a strong determinant of a severe course of COVID-19 with increased mortality. Extracorporeal membrane oxygenation (ECMO) remains the last resort treatment in the critical course of COVID-19 yet may increase the risk of excessive bleeding, especially in the immediate post-cesarean section period. One in five patients receiving ECMO during the COVID-19 pandemic were women who were pregnant or postpartum. While the risk of critical respiratory failure in the peripartum period is high, in an early survey only 52% of pregnant patients intended to receive the COVID-19 vaccine.
Our study aimed to evaluate clinical characteristics and treatment modalities in a series of five pregnant and peripartum women supported with ECMO and anticoagulated with anti-Xa-guided nadroparin therapy in our center. We reviewed the full treatment courses; inflammatory, hemodynamic, and coagulation variables; and maternal and neonatal outcomes. We identified adverse events during the therapy.
All five patients developed acute respiratory distress syndrome due to COVID-19 in the third trimester of pregnancy. Termination of pregnancy occurred between 28 and 36 gestational weeks. While four of five newborns survived to hospital discharge, only two of the five mothers survived to leave hospital.
ECMO is feasible in the third trimester but not devoid of complications. The severity of respiratory failure during COVID-19 and extracorporeal support may not adversely impact neonatal outcomes.
Our study aimed to evaluate clinical characteristics and treatment modalities in a series of five pregnant and peripartum women supported with ECMO and anticoagulated with anti-Xa-guided nadroparin therapy in our center. We reviewed the full treatment courses; inflammatory, hemodynamic, and coagulation variables; and maternal and neonatal outcomes. We identified adverse events during the therapy.
All five patients developed acute respiratory distress syndrome due to COVID-19 in the third trimester of pregnancy. Termination of pregnancy occurred between 28 and 36 gestational weeks. While four of five newborns survived to hospital discharge, only two of the five mothers survived to leave hospital.
ECMO is feasible in the third trimester but not devoid of complications. The severity of respiratory failure during COVID-19 and extracorporeal support may not adversely impact neonatal outcomes.
摘要：
背景：现有数据表明，妊娠是COVID-19严重病程和死亡率增加的重要决定因素。体外膜肺氧合（ECMO）仍然是COVID-19关键过程中的最后手段，但可能会增加过度出血的风险，尤其是在剖宫产后的时期。在COVID-19大流行期间接受ECMO的患者中有五分之一是怀孕或产后的妇女。虽然围产期发生严重呼吸衰竭的风险很高，在早期调查中，只有52%的孕妇打算接种COVID-19疫苗。
方法：我们的研究旨在评估我们中心的一系列5名孕妇和围产期妇女的临床特征和治疗方式，这些妇女接受ECMO支持，并接受抗Xa指导的nadroparin抗凝治疗。我们回顾了完整的治疗过程；炎症，血液动力学,和凝血变量；以及孕产妇和新生儿结局。我们确定了治疗期间的不良事件。
结果：所有5例患者均在妊娠晚期因COVID-19出现急性呼吸窘迫综合征。妊娠终止发生在28至36孕周之间。虽然五个新生儿中有四个幸存下来出院，五名母亲中只有两名幸存下来离开医院。
结论：妊娠晚期ECMO是可行的，但并非没有并发症。COVID-19期间呼吸衰竭的严重程度和体外支持可能不会对新生儿结局产生不利影响。
方法：我们的研究旨在评估我们中心的一系列5名孕妇和围产期妇女的临床特征和治疗方式，这些妇女接受ECMO支持，并接受抗Xa指导的nadroparin抗凝治疗。我们回顾了完整的治疗过程；炎症，血液动力学,和凝血变量；以及孕产妇和新生儿结局。我们确定了治疗期间的不良事件。
结果：所有5例患者均在妊娠晚期因COVID-19出现急性呼吸窘迫综合征。妊娠终止发生在28至36孕周之间。虽然五个新生儿中有四个幸存下来出院，五名母亲中只有两名幸存下来离开医院。
结论：妊娠晚期ECMO是可行的，但并非没有并发症。COVID-19期间呼吸衰竭的严重程度和体外支持可能不会对新生儿结局产生不利影响。
