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Cesarean section in patient with metastatic Ewing sarcoma requiring VA-ECMO support
Joao R Breda1, Oscar Aljure2, Anna K Sfakianaki3
1Division of Thoracic Transplantation and Mechanical Support, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
Abstract:
A 26-year-old pregnant woman, with multiple metastatic Ewing sarcoma, presented with a sternal mass that began enlarging during pregnancy. Due to high-risk pregnancy, the patient was discussed in a multidisciplinary meeting and intubation was considered too risky without cardiopulmonary support. Computed tomography showed extrinsic tumor compression of the right ventricle outflow tract. Veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) was initiated before general anesthesia, followed by Cesarean section (C-section). VA ECMO was initiated with the patient in the awake position, ECMO support was discontinued when the patient had stable ventilation and hemodynamics. This case represents a unique indication of VA ECMO, during C-section, with maternal and fetal survival.
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