Triple Threat: Postpartum, Coronavirus Disease 2019 Positive, and Requiring Extracorporeal Membrane Oxygenation

In the current coronavirus disease 2019 (COVID-19) pandemic, air medical transport has been faced with many challenges that have been taken for granted in the past. The transport of these patients has been shrouded in many controversies, from the appropriate level of personal protective equipment, what facilities are appropriate for which patients, and the appropriate means of transport for COVID-19 patients. When you add in multiple high-risk comorbidities, as well as specialized devices and treatment, the care becomes even more complicated. The case of a 34-year-old, 150-kg, pregnant female who presented to a critical access hospital with shortness of breath and rapid decompensation presented unique challenges when she tested positive for COVID-19. The patient underwent a cesarean section and rapidly decompensated to the point where extracorporeal membrane oxygenation was required. A cardiothoracic surgeon and perfusionist were flown with the flight crew to the critical access hospital to cannulate the patient before transport because of the patient's severely unstable hemodynamic status. The patient was admitted to a tertiary facility for multiple rounds of treatments and was later discharged back to the critical access hospital for rehabilitation and recovery.