P003: ANESTHETIC MANAGEMENT OF A 37 YEAR OLD PREGNANT FEMALE WITH EXTRACORPOREAL MEMBRANE OXYGENATION FOR ACUTE HYPOXIC RESPIRATORY FAILURE SECONDARY TO COVID 19 INFECTION
James Morrow, MD; Harshvardhan Rajen, MD; Javier Lopez, MD, FASA; Kendall Regional Medical Center
Introduction: The patient is a 37 year old female with a past medical history of obesity, hypothyroidism and was 15 weeks pregnant who presented as a transfer from an outside facility. She was intubated the previous day due to acute hypoxic respiratory failure secondary to acute respiratory distress syndrome caused by COVID 19 multifocal pneumonia.
Methods: Consultation from cardiothoracic surgeon and intensivist was determined that the patient would be a candidate for extracorporeal membrane oxygenation and the patient was brought to the operating room for cannulation of veno-venous ECMO. The patient underwent general anesthesia via inhaled anesthetic, in addition to norepinephrine and epinephrine infusion to maintain hemodynamic stability. During the procedure an intraoperative transesophageal echocardiogram was performed by the anesthesiologist during the cannulation of the right internal jugular for confirmation of jet flow into the tricuspid valve. The patient then returned to the intensive care unit.
Results: Unfortunately the patient experienced intrauterine fetal demise 5 days post cannulation with retained products of conception. She then underwent dilation and evacuation with an obstetrician. The patient later went on to develop disseminated intravascular coagulation, with noted petechial hemorrhage into lungs during emergent bronchoscopy. 3 weeks post cannulation the patient had pulseless electrical activity arrest with return of spontaneous circulation obtained 3 times before expiring.
Conclusion: There is limited data on the viability of ECMO treatment of pregnant patients and their survival rates. Typically pregnant women exhibit more severe COVID 19 infections and will have poorer outcomes and undergo complications, often resulting in death of mother and baby.